Provider Demographics
NPI:1386999084
Name:HOLSATHER, SARA LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:HOLSATHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9855 HOSPITAL DR
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4648
Mailing Address - Country:US
Mailing Address - Phone:763-581-5900
Mailing Address - Fax:763-581-5901
Practice Address - Street 1:15700 37TH AVE N STE 300
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3661
Practice Address - Country:US
Practice Address - Phone:612-871-1145
Practice Address - Fax:612-870-5491
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2019-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN11176363AM0700X
MN1767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant