Provider Demographics
NPI:1740160613
Name:PEDERSON, SARA JO (RN, MSN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JO
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35555 820TH ST
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MN
Mailing Address - Zip Code:56119-3123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35555 820TH ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MN
Practice Address - Zip Code:56119-3123
Practice Address - Country:US
Practice Address - Phone:507-360-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1617450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse