Provider Demographics
NPI:1205912375
Name:ATKINSON, SARAH JANE (CAC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STAFFORD ST
Mailing Address - Street 2:PO BOX 80
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-1811
Mailing Address - Country:US
Mailing Address - Phone:920-980-0571
Mailing Address - Fax:
Practice Address - Street 1:55 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-1811
Practice Address - Country:US
Practice Address - Phone:920-980-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI424-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20-5569461OtherEIN#