Healthcare Provider Details

I. General information

NPI: 1548776487
Provider Name (Legal Business Name): SANDRA ENGSTROM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 DWELLEY AVE
DOVER FOXCROFT ME
04426-1005
US

IV. Provider business mailing address

43 DWELLEY AVE
DOVER FOXCROFT ME
04426-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-564-4143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN37625
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: