Provider Demographics
NPI:1083485445
Name:ANDERSON, SARA TERESE
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:TERESE
Last Name:ANDERSON
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 1:42184 COUNTY ROAD 589
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-4437
Mailing Address - Country:US
Mailing Address - Phone:218-969-9668
Mailing Address - Fax:
Practice Address - Street 1:42184 COUNTY ROAD 589
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-4437
Practice Address - Country:US
Practice Address - Phone:218-969-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider