Provider Demographics
NPI:1952697856
Name:LARA, SARA XOCHITL (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:XOCHITL
Last Name:LARA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2203
Mailing Address - Country:US
Mailing Address - Phone:612-873-6963
Mailing Address - Fax:612-352-5990
Practice Address - Street 1:790 W 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2203
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:612-352-5990
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 107520-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily