Provider Demographics
NPI:1467707521
Name:DAUPHINAIS, SARA BERNADETTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:BERNADETTE
Last Name:DAUPHINAIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BERNADETTE DAUPHINAI
Other - Last Name:SCULLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2316
Mailing Address - Country:US
Mailing Address - Phone:612-873-8200
Mailing Address - Fax:
Practice Address - Street 1:44 W 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2316
Practice Address - Country:US
Practice Address - Phone:612-873-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant