| Doctor Name: | SARA WAVRUNEK |
| NPI Number: | 1164878484 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 190795-30 |
| Business Practice Address: | 101 School Creek Trl Luxemburg, WI - 542171095 |
| Business Phone Number: | 9208452351 |
| Business Fax Number: | |
| Mailing Address: | Po Box 19070, GREEN BAY |
| State: | WI |
| Postal Code: | 543079070 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/05/2016 |
| NPI Last Update Date: | 05/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 190795-30 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |