Provider Demographics
NPI:1053470195
Name:PIERRE, SARAH ANN (PAC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:PIERRE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S WEBSTER AVE
Mailing Address - Street 2:OBGYN ASSOCIATES OF GREEN BAY LTD
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-468-3443
Mailing Address - Fax:920-432-6313
Practice Address - Street 1:704 S WEBSTER AVE
Practice Address - Street 2:OBGYN ASSOCIATES OF GREEN BAY LTD
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-468-3443
Practice Address - Fax:920-432-6313
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1510023363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41964300Medicaid
P73556Medicare UPIN
001007050Medicare ID - Type Unspecified