MEDICARE: SANDRA POULTER RN, BSN,SCHOOL NURSE

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	163WS0200X	School Registered Nurse	817093	CA

General Provider Information

NPI Number	:	1447113253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA POULTER RN, BSN,SCHOOL NURSE

Provider Business Mailing Address
First Line	:	226 LA CROSSE AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-3817
Country	:	US
Telephone Number	:	707-322-7655
Fax Number	:

Provider Business Practice Location Address
First Line	:	6950 ANALY AVE
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-3401
Country	:	US
Telephone Number	:	707-322-7655
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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