Healthcare Provider Details

I. General information

NPI: 1982616561
Provider Name (Legal Business Name): SANDRA D ERNST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N 4TH ST
SILSBEE TX
77656-3802
US

IV. Provider business mailing address

755 N 4TH ST
SILSBEE TX
77656-3802
US

V. Phone/Fax

Practice location:
  • Phone: 409-386-1222
  • Fax:
Mailing address:
  • Phone: 409-396-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number242818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: