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Individual

MS. EMILY BURGESS SANDFORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(414) 294-8828
Mailing address
376 CHASE AVE, DE PERE, WI 54115-4071
(414) 294-8288

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA055740
PA
363A00000X
Physician Assistant
Primary
PA173023
OR
363AS0400X
Surgical Physician Assistant
3100-23
WI

Other

Enumeration date
10/04/2012
Last updated
12/28/2021
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