Provider Demographics
NPI:1639337652
Name:SAHLSTROM, BETSY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:
Last Name:SAHLSTROM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10818 280TH ST
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-2885
Mailing Address - Country:US
Mailing Address - Phone:320-532-5876
Mailing Address - Fax:
Practice Address - Street 1:10818 280TH ST
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-2885
Practice Address - Country:US
Practice Address - Phone:320-532-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1013845-2-CFC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care