Healthcare Provider Details

I. General information

NPI: 1699954990
Provider Name (Legal Business Name): SARAH M RUSCH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

IV. Provider business mailing address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-5123
  • Fax: 320-763-7883
Mailing address:
  • Phone: 320-763-2540
  • Fax: 320-766-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10869
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: