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General NPI Number Information
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NPI Number | 1801124565
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Entity Type | Individual
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Provider Name | SANDRA PADDOCK CNP
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Gender | Female
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 1101 LINDEN LN
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City | FARIBAULT
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State | MN
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Zip | 55021-6400
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Country | US
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Telephone | 507-334-0734
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 VILLAGE DR
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City | FARIBAULT
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State | MN
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Zip | 55021-1936
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Country | US
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Telephone | 651-428-3345
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Fax | 320-255-5634
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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 | R 119720-0
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License Number State | MN
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