Provider Demographics
NPI:1053056481
Name:MOUNCE, SARA JANE (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:MOUNCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 EASTWOOD RD SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5363
Mailing Address - Country:US
Mailing Address - Phone:309-287-9054
Mailing Address - Fax:
Practice Address - Street 1:915 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5806
Practice Address - Country:US
Practice Address - Phone:309-287-9054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2466063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse