Provider Demographics
NPI:1184162463
Name:SMITHERMAN, SARA (RN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SMITHERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:GOODENOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N7219 LEIBL CT
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9403
Mailing Address - Country:US
Mailing Address - Phone:507-884-9185
Mailing Address - Fax:
Practice Address - Street 1:N7219 LEIBL CT
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9403
Practice Address - Country:US
Practice Address - Phone:507-884-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI233075163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse