Provider Demographics
NPI:1679285753
Name:MATURA, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MATURA
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 1:2340 EDINBROOK TER
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3731
Mailing Address - Country:US
Mailing Address - Phone:404-924-5791
Mailing Address - Fax:
Practice Address - Street 1:2340 EDINBROOK TER
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3731
Practice Address - Country:US
Practice Address - Phone:404-924-5791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39469310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility