Healthcare Provider Details

I. General information

NPI: 1952767253
Provider Name (Legal Business Name): SARAH TRASER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S WASHINGTON ST: ALTRU PROFESSIONAL CENTER
GRAND FORKS ND
58201-7245
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-7700
  • Fax: 941-697-6010
Mailing address:
  • Phone: 701-780-1891
  • Fax: 309-344-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.013752
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9488337
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR46991
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: