Provider Demographics
NPI:1043472509
Name:RABY, SANDRA KAY (GNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:RABY
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MICHIGAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1406
Mailing Address - Country:US
Mailing Address - Phone:517-205-1731
Mailing Address - Fax:517-205-7649
Practice Address - Street 1:100 E MICHIGAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1406
Practice Address - Country:US
Practice Address - Phone:517-205-1731
Practice Address - Fax:517-205-7649
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704138831363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology