Provider Demographics
NPI:1720089733
Name:SACHS, MARY A (CPNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:SACHS
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Gender:F
Credentials:CPNP
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Mailing Address - Street 1:2910 CENTRE POINTE DR 35-121A
Mailing Address - Street 2:CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 SMITH AVE N
Practice Address - Street 2:CHILDRENS SPECIALTY LCINIC- ASTHMA EDUCATION STPL
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2387
Practice Address - Country:US
Practice Address - Phone:651-220-6101
Practice Address - Fax:651-220-6589
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-08-31
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Provider Licenses
StateLicense IDTaxonomies
MNR121909-4363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN578024100Medicaid
S52996Medicare UPIN