Provider Demographics
NPI:1790886976
Name:IVERSON, SANDRA L (CPNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:IVERSON
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:NORTH METRO PEDIATRICS 10081 DOGWOOD STREET NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448
Mailing Address - Country:US
Mailing Address - Phone:763-783-3722
Mailing Address - Fax:763-783-7944
Practice Address - Street 1:NORTH METRO PEDIATRICS 10081 DOGWOOD STREET NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448
Practice Address - Country:US
Practice Address - Phone:763-783-3722
Practice Address - Fax:763-783-7944
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-10-03
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Provider Licenses
StateLicense IDTaxonomies
MNR 063381-7208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN207209OtherFAIRVIEW
MNHP21983OtherHEALTH PARTNERS
1043948OtherPREFERRED ONE
MN104736OtherU CARE
1576851OtherAMERICAS PPO/ARAZ
WI43929100Medicaid
P00014192OtherRAILROAD MEDICARE
12-00987OtherMEDICA-CHOICE
MT4305613Medicaid
A520OtherCHAMPUS
12-09026OtherMEDICA-PRIMARY
MN941742700Medicaid
MN025A2IVOtherBCBS
WI43929100Medicaid
MN941742700Medicaid