Healthcare Provider Details

I. General information

NPI: 1770560252
Provider Name (Legal Business Name): SANDRA MARIA SKOVLUND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

3800 PARK NICOLLET BLVD CREDENTIALING
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number37928
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: