Healthcare Provider Details

I. General information

NPI: 1598494718
Provider Name (Legal Business Name): ANNA SOPHIA SANDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA SOPHIA VARSOKE PA-C

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RIVARD ST
SOMERSET WI
54025-7382
US

IV. Provider business mailing address

8170 33RD AVE S MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 715-247-2060
  • Fax:
Mailing address:
  • Phone: 952-883-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7602-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: