Individual
JANET SANDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
113 S APPLE ST, SHOSHONE, ID 83352-5287
(208) 886-2224
Mailing address
PO BOX 532, SHOSHONE, ID 83352-0532
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP154
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806524802
—
ID
Enumeration date
11/08/2006
Last updated
02/22/2012
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