Healthcare Provider Details

I. General information

NPI: 1053474445
Provider Name (Legal Business Name): SANDRA JANE RANSOM WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E BEN WHITE BLVD
AUSTIN TX
78704-7301
US

IV. Provider business mailing address

2008 ARPDALE ST
AUSTIN TX
78704-3902
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-5421
  • Fax:
Mailing address:
  • Phone: 512-441-1741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number226714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: