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General NPI Number Information
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NPI Number | 1427624584
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Entity Type | Individual
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Provider Name | SARA RAE OCKER
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Gender | Female
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Dates
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Enumeration Date | 05/31/2021
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 145 2ND AVE SE
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1602
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Country | US
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Telephone | 320-496-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 16909 YELLOW PINE ST NW
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City | ANDOVER
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State | MN
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Zip | 55304-4360
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Country | US
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Telephone | 763-381-9186
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2468063
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9396
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License Number State | MN
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