Healthcare Provider Details

I. General information

NPI: 1972567691
Provider Name (Legal Business Name): SANDRA E MCGRATH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E REELFOOT AVE STE 202 A
UNION CITY TN
38261-6047
US

IV. Provider business mailing address

1720 E REELFOOT AVE STE 202 A
UNION CITY TN
38261-6047
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-3866
  • Fax: 731-885-3868
Mailing address:
  • Phone: 731-885-3866
  • Fax: 731-885-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1607
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: