MEDICARE: ASHLEE SAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1053715953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE SAND

Provider Business Mailing Address
First Line	:	1007 W COLLEGE AVE #502
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401
Country	:	US
Telephone Number	:	707-477-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 W COLLEGE AVE # 502
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5046
Country	:	US
Telephone Number	:	707-477-0025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	10/21/2014

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Directions to “ ASHLEE SAND ” Practice Location

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