Healthcare Provider Details

I. General information

NPI: 1447531512
Provider Name (Legal Business Name): SARA SUZANNE REVIER C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SIXTH AVE N CENTRACARE CLINIC
ST CLOUD MN
56303-2735
US

IV. Provider business mailing address

1200 SIXTH AVE N CENTRACARE CLINIC
ST CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5131
  • Fax:
Mailing address:
  • Phone: 320-252-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0278
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR-156135-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: