Provider Demographics
NPI:1639158439
Name:BARTZ, SANDRA J (RN, CNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:BARTZ
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:5775 WAYZATA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1271
Mailing Address - Country:US
Mailing Address - Phone:952-905-5602
Mailing Address - Fax:
Practice Address - Street 1:5775 WAYZATA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2660
Practice Address - Country:US
Practice Address - Phone:952-738-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 108430-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN354397800Medicaid
MN354397800Medicaid