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General NPI Number Information
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NPI Number | 1801244199
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Entity Type | Individual
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Provider Name | SARA DEZELL R.N.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 1406 6TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1900
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Country | US
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Telephone | 320-656-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 6TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1900
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Country | US
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Telephone | 320-251-2700
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | R 213472-5
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | CNS 0507
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License Number State | MN
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