MEDICARE: MS. SANDRA DAYLE CRUICKSHANK FNP

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	363LF0000X	Family Nurse Practitioner	NUR RN LIC 8033	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114911864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA DAYLE CRUICKSHANK FNP

Provider Business Mailing Address
First Line	:	100 WEST WICKS LANE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-1539
Country	:	US
Telephone Number	:	406-294-8643
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WEST WICKS LANE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-1539
Country	:	US
Telephone Number	:	406-294-8643
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	09/14/2015

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