Individual
MS. MARY E SANDEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 771-5662
(928) 771-5249
Mailing address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 771-5662
(928) 771-5249
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN104425
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
468373
—
AZ
Enumeration date
07/27/2006
Last updated
02/03/2012
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