Provider Demographics
NPI:1821220534
Name:HARTMAN, SARA M (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2570
Mailing Address - Country:US
Mailing Address - Phone:920-727-5810
Mailing Address - Fax:920-727-5852
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2570
Practice Address - Country:US
Practice Address - Phone:920-727-5810
Practice Address - Fax:920-727-5852
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100005000Medicaid