Provider Demographics
NPI:1538631940
Name:MARSHALL, SARA (APNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:LOUGHRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-417-6000
Mailing Address - Fax:
Practice Address - Street 1:6408 COPPS AVE
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3702
Practice Address - Country:US
Practice Address - Phone:608-417-3000
Practice Address - Fax:608-417-3100
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157426163W00000X
390200000X
WI9017-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program