Provider Demographics
NPI:1699701672
Name:BOT, SARAH TERESA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:TERESA
Last Name:BOT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:TERESA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:6525 FRANCE AVE SOUTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3624
Mailing Address - Country:US
Mailing Address - Phone:952-927-4021
Mailing Address - Fax:952-927-4026
Practice Address - Street 1:6525 FRANCE AVE SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3624
Practice Address - Country:US
Practice Address - Phone:932-927-4021
Practice Address - Fax:952-927-4026
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10018363A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNQ68844Medicare UPIN