Provider Demographics
NPI:1881895209
Name:DOXTATER, SANDRA L (APNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:DOXTATER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:HAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:959 N MAYFAIR RD
Mailing Address - Street 2:PAIN MANAGEMENT CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3465
Mailing Address - Country:US
Mailing Address - Phone:414-456-7610
Mailing Address - Fax:414-456-6024
Practice Address - Street 1:959 N MAYFAIR RD
Practice Address - Street 2:PAIN MANAGEMENT CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3465
Practice Address - Country:US
Practice Address - Phone:414-456-7610
Practice Address - Fax:414-456-6024
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1402363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881895209Medicaid
WIK400132730Medicare PIN