Active NPI
Sara L Rosendahl, PAC
- Medical Physician Assistant
- Thief River Falls, MN
National Provider Identifier
1962607143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 9495
- Practice address
- 1720 Highway 59 S
Thief River Falls, MN 56701-4331 - Phone
- (218) 681-4747
- Fax
- (218) 683-2595
- NPI assigned
- Jun 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9495 | MN | |
| Medical Physician Assistant | 363AM0700X | 9495 | MN | Primary |
Addresses
Primary practice location
1720 Highway 59 S
Thief River Falls, MN 56701-4331
Mailing address
1720 Highway 59 S
Thief River Falls, MN 56701-4331
Phone (218) 681-4747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9495 | MN | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1962607143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1720 HIGHWAY 59 S",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567014331",
"telephone_number": "218-681-4747",
"fax_number": "218-683-2595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 HIGHWAY 59 S",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567014331",
"telephone_number": "218-681-4747",
"fax_number": "218-683-2595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENDAHL",
"first_name": "SARA",
"middle_name": "L",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-18",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "9495",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MN",
"license": "9495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thief River Falls, MN
- Timothy Mark Rittenour, M.D.
- Riverview Healthcare Association (Riverview Recovery Center)
- Riverview Healthcare Association
- Ronco Lifts Inc (Ronco Lifts and Rehab Products)
- Kim J Rosendahl, PT
- Amanda Rositas Kjos, OTR/L
- Jaclyn Rudoni, ATC
- Nancy E Rust, PHD
- S&S Rehab Products Plus, Inc.
- Sanford Clinic North (Sanford Pharmacy Thief River Falls 340B)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.