Provider Demographics
NPI:1013971183
Name:BASSETT, SARAH BETH (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:BETH
Last Name:BASSETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1219
Mailing Address - Country:US
Mailing Address - Phone:262-728-8593
Mailing Address - Fax:
Practice Address - Street 1:213 N 7TH ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1219
Practice Address - Country:US
Practice Address - Phone:262-728-8593
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38320700Medicare ID - Type UnspecifiedINDEPENDENT NURSE PROVIDE