Provider Demographics
NPI:1003046558
Name:HEATH, SANDRA JEAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:HEATH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:SCHASTEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8810 N 127TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5016
Mailing Address - Country:US
Mailing Address - Phone:918-716-0028
Mailing Address - Fax:
Practice Address - Street 1:8810 N 127TH EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5016
Practice Address - Country:US
Practice Address - Phone:918-716-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-18
Last Update Date:2009-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0026953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily