Provider Demographics
NPI:1730128505
Name:ISAKSON, SARAH LOUISE (GNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE
Last Name:ISAKSON
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 ROOSEVELT STREET NE
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1543
Mailing Address - Country:US
Mailing Address - Phone:612-590-0411
Mailing Address - Fax:
Practice Address - Street 1:MAIL ROUTE 11414
Practice Address - Street 2:800 E. 28TH STREET
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3799
Practice Address - Country:US
Practice Address - Phone:612-863-3110
Practice Address - Fax:612-863-3158
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR113615-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN339797100Medicaid