Provider Demographics
NPI:1144456989
Name:LIEGL, SARAH L (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:LIEGL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:L
Other - Last Name:FUENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6207 WILLIAMSBURG WAY APT 112
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-9124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 ALICE PECK DAY DR UNIT C
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2684
Practice Address - Country:US
Practice Address - Phone:603-448-6344
Practice Address - Fax:603-448-3405
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002944363A00000X
WI4284363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant