Healthcare Provider Details

I. General information

NPI: 1265513980
Provider Name (Legal Business Name): SANDRA JEAN CAGLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA JEAN PARRY RN MSN CCRN ARNP

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

IV. Provider business mailing address

7306 CREEK VIEW CIR
WEST BLOOMFIELD MI
48322-3512
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-7807
  • Fax:
Mailing address:
  • Phone: 248-865-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number4704147038
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: