Provider Demographics
NPI:1164036679
Name:SAKOWSKI, MARK (RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SAKOWSKI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 S ROYS LAND RD
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4537
Mailing Address - Country:US
Mailing Address - Phone:218-464-7463
Mailing Address - Fax:
Practice Address - Street 1:3968 S ROYS LAND RD
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4537
Practice Address - Country:US
Practice Address - Phone:218-464-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2485464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse