Provider Demographics
NPI:1114818481
Name:WILSON, SARA JEAN (RN, SANE-A)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, SANE-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-5011
Mailing Address - Country:US
Mailing Address - Phone:701-640-6936
Mailing Address - Fax:
Practice Address - Street 1:1438 14TH AVE N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-5011
Practice Address - Country:US
Practice Address - Phone:701-640-6936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-176814-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse