Individual
SHANNON N SANDSTROM
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
137 CAMBRIA ST, RANDOLPH, WI 53956
(920) 326-5303
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2722
WI
Other
Enumeration date
05/18/2006
Last updated
07/08/2007
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