| NPI | 1508266842 |
|---|---|
| Former Name | SANDIE JEAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 005821) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 5821) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2018-06-27 |