Provider Demographics
NPI:1679287668
Name:FRY, SARA LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:FRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31701 710TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND MEADOW
Mailing Address - State:MN
Mailing Address - Zip Code:55936-8645
Mailing Address - Country:US
Mailing Address - Phone:507-696-6340
Mailing Address - Fax:
Practice Address - Street 1:720 WASHINGTON AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2924
Practice Address - Country:US
Practice Address - Phone:612-884-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant