Healthcare Provider Details

I. General information

NPI: 1922034768
Provider Name (Legal Business Name): SARA V BERNSTEIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA V SEE RD

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 WOODWINDS DR
SAINT PAUL MN
55125-2270
US

IV. Provider business mailing address

1997 SAFARI TRL
EAGAN MN
55122-2610
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-0100
  • Fax:
Mailing address:
  • Phone: 651-702-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1982
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: