Healthcare Provider Details

I. General information

NPI: 1386877579
Provider Name (Legal Business Name): SANDRA LYNNE CORRIGAN FNP-BC, CNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 ROLLING OAKS DR STE 100
THOUSAND OAKS CA
91361-1024
US

IV. Provider business mailing address

PO BOX 2160
MOORPARK CA
93020-2160
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7775
  • Fax: 805-557-1074
Mailing address:
  • Phone: 818-718-2301
  • Fax: 818-718-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License NumberNP19226
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: