Provider Demographics
NPI:1518302090
Name:VANDERSTOEP, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VANDERSTOEP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:MN
Mailing Address - Zip Code:56128-1247
Mailing Address - Country:US
Mailing Address - Phone:507-442-3557
Mailing Address - Fax:
Practice Address - Street 1:1091 N HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-2286
Practice Address - Country:US
Practice Address - Phone:507-825-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR81048-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse