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General NPI Number Information
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NPI Number | 1164442638
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Entity Type | Individual
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Provider Name | SANDRA MARY OEHLKE C.P.N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 2795 PILOT KNOB RD SUITE 300
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City | EAGAN
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State | MN
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Zip | 55121-1176
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Country | US
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Telephone | 651-379-9999
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Fax | 651-379-9900
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Provider Business Mailing Address
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Address Line | 4689 GLENBROOK AVE N
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City | OAKDALE
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State | MN
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Zip | 55128-2321
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Country | US
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Telephone | 612-863-8563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 20020486
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License Number State | MN
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