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Individual
MRS. SARAH LYNETTE SANDOVAL
Active
Individual
MRS. SARAH LYNETTE SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041427444
IL
207QA0505X
Adult Medicine Physician
2012020830
MO
363LF0000X
Family Nurse Practitioner
Primary
209016207
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649315219
—
MO
Enumeration date
09/28/2017
Last updated
09/03/2019
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