MEDICARE: MS. SANDY MEADE NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2645-033	WI

General Provider Information

NPI Number	:	1063492718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDY MEADE NP

Provider Business Mailing Address
First Line	:	4700 DRESSER DR
Second Line	:	STE 100
City	:	JANESVILLE
State	:	WI
Zip	:	53546-9160
Country	:	US
Telephone Number	:	815-395-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 N ALPINE RD STE 260
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1481
Country	:	US
Telephone Number	:	815-395-1500
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	12/08/2019

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