Provider Demographics
NPI:1932464088
Name:BJORKLUND, SARA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:BJORKLUND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:DUFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:003-262-2508
Mailing Address - Fax:
Practice Address - Street 1:4600 W LOOMIS RD
Practice Address - Street 2:#201
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220
Practice Address - Country:US
Practice Address - Phone:414-908-6500
Practice Address - Fax:414-908-6515
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2950-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100044515Medicaid