Healthcare Provider Details

I. General information

NPI: 1194199752
Provider Name (Legal Business Name): SARA MARIE HUGOSON RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA MARIE WELLENSTEIN RN

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 PHALEN BLVD
SAINT PAUL MN
55106-2126
US

IV. Provider business mailing address

2838 60TH ST
GRANADA MN
56039-3144
US

V. Phone/Fax

Practice location:
  • Phone: 612-513-6694
  • Fax: 651-493-4221
Mailing address:
  • Phone: 507-525-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2459635
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number225556
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6239
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: