| Doctor Name: | KERRY SACKMAN |
| NPI Number: | 1326352840 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | R168818-8 |
| Business Practice Address: | 11091 Jason Ave Ne Albertville, MN - 553014699 |
| Business Phone Number: | 7636848300 |
| Business Fax Number: | 7634975852 |
| Mailing Address: | 11091 Jason Ave Ne, ALBERTVILLE |
| State: | MN |
| Postal Code: | 553014699 |
| Phone Number: | 7636848300 |
| Fax Number: | 7634975852 |
| NPI Enumeration Date: | 07/27/2010 |
| NPI Last Update Date: | 10/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R168818-8 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |