MEDICARE: SARAH KATHERINE GHIZONI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	10172	MN

General Provider Information

NPI Number	:	1841988300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KATHERINE GHIZONI NP

Provider Business Mailing Address
First Line	:	7900 WEDGEWOOD LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-9403
Country	:	US
Telephone Number	:	763-746-6414
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 WEDGEWOOD LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-9403
Country	:	US
Telephone Number	:	763-746-6414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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