Provider Demographics
NPI:1871130336
Name:MITHUN, SARAH JUDITH (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JUDITH
Last Name:MITHUN
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:JUDITH
Other - Last Name:MITHUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:525 PORTLAND AVE # MC963
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-348-5553
Mailing Address - Fax:
Practice Address - Street 1:525 PORTLAND AVE # MC963
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1533
Practice Address - Country:US
Practice Address - Phone:612-348-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF10190891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily