Provider Demographics
NPI:1205569993
Name:GULLENS, SADECA
Entity type:Individual
Prefix:
First Name:SADECA
Middle Name:
Last Name:GULLENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 MONONA DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3329
Mailing Address - Country:US
Mailing Address - Phone:608-440-3481
Mailing Address - Fax:
Practice Address - Street 1:2317 INTERNATIONAL LN STE 114
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3154
Practice Address - Country:US
Practice Address - Phone:608-471-4127
Practice Address - Fax:855-316-1039
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246RP1900X
WI247ZC0005X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician