Provider Demographics
NPI:1578804670
Name:MESTAD, SARA MARIE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:MESTAD
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:KELZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7450 FRANCE AVE S. STE 240
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-893-9100
Mailing Address - Fax:952-893-9105
Practice Address - Street 1:7450 FRANCE AVE S. STE 240
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-893-9100
Practice Address - Fax:952-893-9109
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1853845363L00000X, 363LF0000X
MN2320363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR1853845OtherLICENSE