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General NPI Number Information
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NPI Number | 1285485292
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Entity Type | Individual
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Provider Name | DONNA MICHELLE SANDOVAL
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1049 E NEWELL ST
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City | WHITE CLOUD
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State | MI
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Zip | 49349-8795
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Country | US
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Telephone | 231-872-9486
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Fax |
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Provider Business Mailing Address
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Address Line | 7323 S FITZGERALD AVE
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City | FREMONT
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State | MI
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Zip | 49412-8179
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Country | US
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Telephone | 231-872-9487
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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