Healthcare Provider Details

I. General information

NPI: 1144592486
Provider Name (Legal Business Name): SARA B HANSEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA B TOLLEFSON

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 56TH ST S STE D
FARGO ND
58104-4845
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-6600
  • Fax: 701-364-6628
Mailing address:
  • Phone: 701-364-6600
  • Fax: 701-364-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR27559
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: