Provider Demographics
NPI:1013274356
Name:QUADE, SANDRALEE S (NP)
Entity Type:Individual
Prefix:
First Name:SANDRALEE
Middle Name:S
Last Name:QUADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 W FOND DU LAC ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-9286
Mailing Address - Country:US
Mailing Address - Phone:920-748-7000
Mailing Address - Fax:
Practice Address - Street 1:1080 W FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9286
Practice Address - Country:US
Practice Address - Phone:920-748-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4819363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1013274356Medicaid
WI222450427Medicare PIN