Provider Demographics
NPI:1053565861
Name:SIMONSON, SARA LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNNE
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNNE
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1012 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2200
Mailing Address - Country:US
Mailing Address - Phone:218-249-2450
Mailing Address - Fax:218-249-2451
Practice Address - Street 1:1012 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2200
Practice Address - Country:US
Practice Address - Phone:218-249-2450
Practice Address - Fax:218-249-2451
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103577225X00000X
MN2300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist