MEDICARE: ERIN NETTELAND-SANDVIG DO

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	207Q00000X	Family Medicine Physician	3966	IA
2	207Q00000X	Family Medicine Physician	36107387	IL

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	:	1396793600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN NETTELAND-SANDVIG DO

Provider Business Mailing Address
First Line	:	PO BOX 1475
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50305-1475
Country	:	US
Telephone Number	:	515-222-7000
Fax Number	:	515-222-7037

Provider Business Practice Location Address
First Line	:	1601 NW 114TH ST
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-7007
Country	:	US
Telephone Number	:	515-222-7000
Fax Number	:	515-222-7037

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	05/03/2023

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