Active NPI
Nicole F Sandberg
- Pharmacist
- Baraboo, WI
National Provider Identifier
1376704148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15057
- Practice address
- 1700 Tuttle St
Suite 300
Baraboo, WI 53913-3319 - Phone
- (608) 356-6966
- Fax
- (608) 355-7282
- NPI assigned
- Jun 24, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15057 | WI | Primary |
Addresses
Primary practice location
1700 Tuttle St
Suite 300
Baraboo, WI 53913-3319
Mailing address
1808 W Beltline Hwy
Madison, WI 53713-2334
Phone (608) 250-1408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15057 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214265600000",
"number": "1376704148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1808 W BELTLINE HWY",
"city": "MADISON",
"state": "WI",
"postal_code": "537132334",
"telephone_number": "608-250-1408",
"fax_number": "608-250-1463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 TUTTLE ST",
"address_2": "SUITE 300",
"city": "BARABOO",
"state": "WI",
"postal_code": "539133319",
"telephone_number": "608-356-6966",
"fax_number": "608-355-7282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDBERG",
"first_name": "NICOLE",
"middle_name": "F",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-24",
"last_updated": "2008-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "15057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baraboo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.