MEDICARE: SANDRA E MCGRATH NP

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	363L00000X	Nurse Practitioner	1607	TN

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
2	200448096	OTHER	TN	FEDRERAL TAX ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4075871	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972567691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA E MCGRATH NP

Provider Business Mailing Address
First Line	:	1720 E REELFOOT AVE
Second Line	:	STE 202 A
City	:	UNION CITY
State	:	TN
Zip	:	38261-6047
Country	:	US
Telephone Number	:	731-885-3866
Fax Number	:	731-885-3868

Provider Business Practice Location Address
First Line	:	1720 E REELFOOT AVE
Second Line	:	STE 202 A
City	:	UNION CITY
State	:	TN
Zip	:	38261-6047
Country	:	US
Telephone Number	:	731-885-3866
Fax Number	:	731-885-3868

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	12/04/2009

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Directions to “ SANDRA E MCGRATH NP” Practice Location

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