Provider Demographics
NPI:1316916026
Name:ANDERSON, SANDRA (PA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:ESTENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1 GENERAL MILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1347
Mailing Address - Country:US
Mailing Address - Phone:763-764-4448
Mailing Address - Fax:763-764-6180
Practice Address - Street 1:1 GENERAL MILLS BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-1347
Practice Address - Country:US
Practice Address - Phone:763-764-4448
Practice Address - Fax:763-764-6180
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN702600500Medicaid
S86713Medicare UPIN
970001294Medicare ID - Type Unspecified