Provider Demographics
NPI:1124142849
Name:STODDARD, SARAH ANNE (MS, RN, CNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:STODDARD
Suffix:
Gender:F
Credentials:MS, RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14082 TOLEDO CT
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1972
Mailing Address - Country:US
Mailing Address - Phone:612-481-2664
Mailing Address - Fax:
Practice Address - Street 1:14790 119TH ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-8906
Practice Address - Country:US
Practice Address - Phone:651-439-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 128860-1163W00000X, 363LP0200X
MN19990640363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP29133Medicare UPIN