Provider Demographics
NPI:1154324846
Name:PACKARD, SARA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:PACKARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:SCHRAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 NW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5503
Mailing Address - Country:US
Mailing Address - Phone:507-451-1120
Mailing Address - Fax:507-444-6287
Practice Address - Street 1:2200 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5503
Practice Address - Country:US
Practice Address - Phone:507-451-1120
Practice Address - Fax:507-444-6287
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC624363A00000X
TN1233363A00000X
MN9780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3663349Medicaid
MN970003541OtherMEDICARE
MN970003541OtherMEDICARE
P76200Medicare UPIN