Healthcare Provider Details

I. General information

NPI: 1770417412
Provider Name (Legal Business Name): SARAH EDWARDY BSN, RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 FORD RD
ST LOUIS PARK MN
55426-1099
US

IV. Provider business mailing address

11205 GOODHUE ST NE
BLAINE MN
55449-4415
US

V. Phone/Fax

Practice location:
  • Phone: 952-378-1800
  • Fax:
Mailing address:
  • Phone: 612-751-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR167618-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: