Healthcare Provider Details

I. General information

NPI: 1023451317
Provider Name (Legal Business Name): SARAH LAYNE CRANDALL M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 LONDON RD STE 101
DULUTH MN
55805-2437
US

IV. Provider business mailing address

1420 LONDON RD STE 101
DULUTH MN
55805-2437
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-7363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberPG189173
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD60951421
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number74191
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: