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Individual

MRS. SARAH JOANNA TEN EYCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 948-5600

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085003081
IL
363A00000X
Physician Assistant
Primary
2208
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100007504
WI
Enumeration date
12/12/2007
Last updated
11/14/2023
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