Provider Demographics
NPI:1427568500
Name:REVERMANN, SARAH JANE (APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:REVERMANN
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:SOPKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362
Mailing Address - Country:US
Mailing Address - Phone:320-243-3767
Mailing Address - Fax:
Practice Address - Street 1:200 W 1ST ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1445
Practice Address - Country:US
Practice Address - Phone:320-243-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily