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SHANNON N SANDSTROM NP

Adult Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1194778324

Individual Registrant:
 SHANNON N SANDSTROM NP
Gender: F

Location and contact information for practice:
137 CAMBRIA ST  RANDOLPH, WI 53956 US
Tel: 920-326-5303  Fax: --

Contact information for business:
420 E DIVISION ST  FOND DU LAC, WI 54935-4560 US
Tel: 920-926-8340  Fax: --

Registration Information:
NPI: 1194778324
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LA2200XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Adult Health
WI2722

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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