MEDICARE: SANDRA L MAJETICH NURSE PRACTITIONER

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	APRN.CNP.0033890	OH

General Provider Information

NPI Number	:	1568140697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L MAJETICH NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1280 BOARDMAN CANFIELD RD STE 3
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-4073
Country	:	US
Telephone Number	:	330-540-5409
Fax Number	:	330-726-0843

Provider Business Practice Location Address
First Line	:	1280 BOARDMAN CANFIELD RD STE 3
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-4073
Country	:	US
Telephone Number	:	330-726-1900
Fax Number	:	330-726-0843

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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