Healthcare Provider Details

I. General information

NPI: 1245622927
Provider Name (Legal Business Name): SANDRA MACHON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BROWN ST
WASHINGTON NC
27889-4671
US

IV. Provider business mailing address

1206 BROWN ST
WASHINGTON NC
27889-4671
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-4134
  • Fax:
Mailing address:
  • Phone: 252-946-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number251021
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: