Provider Demographics
NPI:1174704084
Name:CARABACAN, SARAH BURRIE
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BURRIE
Last Name:CARABACAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 116TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3262
Mailing Address - Country:US
Mailing Address - Phone:414-507-3798
Mailing Address - Fax:
Practice Address - Street 1:1300 N 116TH ST
Practice Address - Street 2:APT 3
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3262
Practice Address - Country:US
Practice Address - Phone:414-507-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35042000Medicaid