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General NPI Number Information
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NPI Number | 1699777649
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Entity Type | Individual
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Provider Name | SANDRA L ELLIOTT F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | 39350 9 MILE RD
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City | NORTHVILLE
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State | MI
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Zip | 48167-9164
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Country | US
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Telephone | 248-425-5149
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Fax |
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Provider Business Mailing Address
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Address Line | 3719 HI DALE DR
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City | LAKE ORION
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State | MI
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Zip | 48360-2422
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Country | US
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Telephone | 248-391-0114
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704077181
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License Number State | MI
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