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Contact Information

SANDRA L DAVENPORT, MD
6109 W 105TH ST
BLOOMINGTON, MN55438-1833
 Phone: 952-831-5522
 Fax: 952-831-0381
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Genetics (M.D.)

207SG0201X
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for SANDRA L DAVENPORT · (Female)

NPI Number 1912044918
Status Active
Credentials MD
Entity Individual
Enumeration date 01/30/2007
Last updated 09/17/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 29543
  • MN Medicaid 2034451
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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