Provider Demographics
NPI:1558653568
Name:LEWIS, SARA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:SCHROER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6500 EXCELSIOR BLVD
Mailing Address - Street 2:PARK NICOLLET CLINIC- HEART & VASCULAR CENTER
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4702
Mailing Address - Country:US
Mailing Address - Phone:952-993-3360
Mailing Address - Fax:
Practice Address - Street 1:14000 NICOLLET AVE STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-428-0200
Practice Address - Fax:952-428-0199
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1548363AS0400X
MN10953363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical