Provider Demographics
NPI:1295196350
Name:PEARCE, SARA (APRN CNM IBCLC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:APRN CNM IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1225
Mailing Address - Country:US
Mailing Address - Phone:952-285-4452
Mailing Address - Fax:
Practice Address - Street 1:3511 HAZELTON RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4208
Practice Address - Country:US
Practice Address - Phone:952-926-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNM0189176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife