Healthcare Provider Details

I. General information

NPI: 1669337242
Provider Name (Legal Business Name): SARA JANE AMUNDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10912 GREENBRIER RD
MINNETONKA MN
55305-3474
US

IV. Provider business mailing address

255 WESTERN AVE N APT 309
SAINT PAUL MN
55102-4713
US

V. Phone/Fax

Practice location:
  • Phone: 952-935-0600
  • Fax:
Mailing address:
  • Phone: 651-235-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2134
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: