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NPI Code Detail

MEDICARE: SARAH CHRISTINA CORNELL PA-S

MEDICARE: SARAH CHRISTINA CORNELL PA-S
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
1363A00000XPhysician Assistant15548MN
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1619667813
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH CHRISTINA CORNELL PA-S
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-849-4559
Fax Number :
Provider Business Practice Location Address
First Line : 4040 COON RAPIDS BLVD NW STE 120
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-4568
Country : US
Telephone Number : 763-427-9980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2023
Last Update Date : 05/07/2026

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Directions to “ SARAH CHRISTINA CORNELL PA-S” Practice Location

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