Basic Information
| Provider Information | |||||||||
| NPI: | 1720302185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDMAN | ||||||||
| FirstName: | LAQUITA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98 | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385560098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318795864 | ||||||||
| FaxNumber: | 9318791402 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 DUNCAN STREET | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385560098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318795864 | ||||||||
| FaxNumber: | 9318791402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2010 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN14778 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.