Provider Demographics
NPI:1003837493
Name:BEEMAN, SANDRA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BEEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:HOOPER BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99604-0049
Mailing Address - Country:US
Mailing Address - Phone:907-758-3500
Mailing Address - Fax:
Practice Address - Street 1:AIRPORT ROAD
Practice Address - Street 2:YKHC
Practice Address - City:HOOPER BAY
Practice Address - State:AK
Practice Address - Zip Code:99604-0049
Practice Address - Country:US
Practice Address - Phone:907-758-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3204363A00000X
NC001001117363A00000X
AKPAD T 2280363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSO1250Medicare UPIN