Healthcare Provider Details

I. General information

NPI: 1164202537
Provider Name (Legal Business Name): SARAH RAE SCHOMMER RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E BROADWAY AVE
BISMARCK ND
58501-4407
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-5600
  • Fax: 701-323-5604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR40700
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: