Provider Demographics
NPI:1164442638
Name:OEHLKE, SANDRA MARY (CPNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARY
Last Name:OEHLKE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 GLENBROOK AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-2321
Mailing Address - Country:US
Mailing Address - Phone:612-863-8563
Mailing Address - Fax:
Practice Address - Street 1:2795 PILOT KNOB RD
Practice Address - Street 2:SUITE 300
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1176
Practice Address - Country:US
Practice Address - Phone:651-379-9999
Practice Address - Fax:651-379-9900
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20020486363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1202377OtherMEDICA
MN142732OtherUCARE
312J3OEOtherBLUE CROSS BLUE SHIELD
968421032508OtherPREFERRED ONE
ND13837Medicaid
MN1202377OtherMEDICA
MN321J30EOtherBCBS
2273311OtherSELECT CARE
HP37239OtherHEALTH PARTNERS
ND13837Medicaid