Healthcare Provider Details

I. General information

NPI: 1780790311
Provider Name (Legal Business Name): SANDRA JEAN SLATER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD CLINIC 11
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD CLINIC 11
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 180-084-9359
  • Fax: 214-462-4958
Mailing address:
  • Phone: 180-084-9359
  • Fax: 214-462-4958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number445505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: