Healthcare Provider Details

I. General information

NPI: 1023036985
Provider Name (Legal Business Name): SARAH MOONEY BECKMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH COLE MOONEY

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 1ST ST NE
FARIBAULT MN
55021-5441
US

IV. Provider business mailing address

924 1ST ST NE
FARIBAULT MN
55021-5441
US

V. Phone/Fax

Practice location:
  • Phone: 507-333-3300
  • Fax: 507-333-3214
Mailing address:
  • Phone: 507-333-3300
  • Fax: 507-333-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30737
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: