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NPI Code Detail

MEDICARE: SARA I HUSBY COTA/L

MEDICARE: SARA I HUSBY COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility201299MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295965846
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA I HUSBY COTA/L
Provider Business Mailing Address
First Line : 1920 ROOSEVELT DR APT 54
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-3512
Country : US
Telephone Number : 218-396-0351
Fax Number :
Provider Business Practice Location Address
First Line : 815 FOREST AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1643
Country : US
Telephone Number : 507-664-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2009
Last Update Date : 07/16/2009

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Directions to “ SARA I HUSBY COTA/L” Practice Location

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