Healthcare Provider Details

I. General information

NPI: 1053571109
Provider Name (Legal Business Name): KATE M. SANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 3RD ST NW RIVERWAY CLINIC-ELK RIVER-MAIL STOP 39400A
ELK RIVER MN
55330-8863
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-4800
  • Fax: 763-587-4885
Mailing address:
  • Phone: 763-587-4800
  • Fax: 763-587-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-8309
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53747
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: