Healthcare Provider Details

I. General information

NPI: 1952387854
Provider Name (Legal Business Name): LETICIA SANDROCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WIESBADEN ARMY HEALTH CLINIC UNIT 29623
APO AE
09096
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 496117055332
  • Fax:
Mailing address:
  • Phone: 496371868839
  • Fax: 6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number125932
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: