Healthcare Provider Details

I. General information

NPI: 1124142849
Provider Name (Legal Business Name): SARAH ANNE STODDARD MS, RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14790 119TH ST N
STILLWATER MN
55082-8906
US

IV. Provider business mailing address

14082 TOLEDO CT
SAVAGE MN
55378-1972
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-8484
  • Fax:
Mailing address:
  • Phone: 612-481-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 128860-1
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR 128860-1
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number19990640
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: