Provider Demographics
NPI:1427624584
Name:OCKER, SARA RAE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RAE
Last Name:OCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:RAE
Other - Last Name:CROASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16909 YELLOW PINE ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4360
Mailing Address - Country:US
Mailing Address - Phone:763-381-9186
Mailing Address - Fax:
Practice Address - Street 1:145 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1602
Practice Address - Country:US
Practice Address - Phone:320-496-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2468063163W00000X
MN9396363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse