Provider Demographics
NPI:1194199752
Name:HUGOSON, SARA MARIE (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIE
Last Name:HUGOSON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:WELLENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1950 CENTER CREEK DR # 100
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3428
Mailing Address - Country:US
Mailing Address - Phone:507-238-4968
Mailing Address - Fax:
Practice Address - Street 1:1950 CENTER CREEK DR # 100
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3428
Practice Address - Country:US
Practice Address - Phone:507-238-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2459635163W00000X
WI225556163W00000X
MN6239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse