Provider Demographics
NPI:1295764736
Name:VAN SAUN, SARAH A (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:VAN SAUN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:21700 INTERTECH DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5197
Mailing Address - Country:US
Mailing Address - Phone:262-532-8300
Mailing Address - Fax:
Practice Address - Street 1:21700 INTERTECH DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5197
Practice Address - Country:US
Practice Address - Phone:262-532-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17982083X0100X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41996900Medicare ID - Type Unspecified
WI0335 68086Medicare PIN