Individual
MRS. CATHY DIANE SANDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M5331
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005930
BLUE SHIELD
—
01
—
01338
BLUE CROSS OF ID
—
05
—
804257200
—
ID
Enumeration date
10/17/2005
Last updated
11/07/2012
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