Healthcare Provider Details

I. General information

NPI: 1952455966
Provider Name (Legal Business Name): SARAH A BEMENT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST
MAHNOMEN MN
56557-4003
US

IV. Provider business mailing address

1027 WASHINGTON AVE
DETROIT LAKES MN
56501-3409
US

V. Phone/Fax

Practice location:
  • Phone: 218-936-5616
  • Fax:
Mailing address:
  • Phone: 218-936-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11572
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: