Provider Demographics
NPI:1649755000
Name:IVERSON, SARAH ROMELL (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROMELL
Last Name:IVERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROMELL
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6545 FRANCE AVE S STE 490
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2123
Mailing Address - Country:US
Mailing Address - Phone:952-922-7600
Mailing Address - Fax:952-345-4448
Practice Address - Street 1:6545 FRANCE AVE S STE 490
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2123
Practice Address - Country:US
Practice Address - Phone:529-227-6009
Practice Address - Fax:523-454-4489
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant