Individual
SANDRA LEE MARCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1 HIGHWAY 16, DEER, AR 72628
(780) 428-5391
(870) 428-5391
Mailing address
PO BOX 130, DEER, AR 72628-0130
(870) 428-5391
(870) 428-5391
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A01436
AR
363L00000X
Nurse Practitioner
NP782A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142695
REGENCE OF ID GROUP
ID
01
—
000010160675
REGENCE OF ID
ID
01
—
043634356
BRCHC TAX ID
ID
05
—
806590100
—
ID
01
—
8H104
BLUE CROSS OF ID GROUP
ID
01
—
NPYH4
BLUE CROSS OF ID
ID
Enumeration date
06/16/2005
Last updated
08/01/2008
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