Provider Demographics
NPI:1366812976
Name:FODNESS, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FODNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1012
Mailing Address - Country:US
Mailing Address - Phone:605-444-8289
Mailing Address - Fax:605-444-8431
Practice Address - Street 1:4928 N CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0563
Practice Address - Country:US
Practice Address - Phone:605-444-8820
Practice Address - Fax:605-444-8821
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDCP000985OtherCNP LICENSE