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NPI Code Detail

MEDICARE: SANDEE M VOLATILE CRNP

MEDICARE: SANDEE M VOLATILE CRNP
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
1363LP2300XPrimary Care Nurse PractitionerLG0000220DE
2363L00000XNurse PractitionerAP116167TX
3363LF0000XFamily Nurse Practitioner741573TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18J7892OTHERTXMEDICARE/PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
28Y2104OTHERTXBCBS

General Provider Information

NPI Number : 1932166881
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDEE M VOLATILE CRNP
Provider Business Mailing Address
First Line : 1910 ROSELAND BLVD
Second Line :
City : TYLER
State : TX
Zip : 75701-4246
Country : US
Telephone Number : 903-533-0644
Fax Number : 903-533-0644
Provider Business Practice Location Address
First Line : 1910 ROSELAND BLVD
Second Line :
City : TYLER
State : TX
Zip : 75701-4246
Country : US
Telephone Number : 903-533-0644
Fax Number : 903-533-0644
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 05/24/2022

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Directions to “ SANDEE M VOLATILE CRNP” Practice Location

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