Basic Information
| Provider Information | |||||||||
| NPI: | 1558653568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHROER | ||||||||
| OtherFirstName: | SARA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6500 EXCELSIOR BLVD | ||||||||
| Address2: | PARK NICOLLET CLINIC- HEART & VASCULAR CENTER | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554264702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529933360 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14000 NICOLLET AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524280200 | ||||||||
| FaxNumber: | 9524280199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 06/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 1548 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AM0700X | 10953 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.