Provider Demographics
NPI:1083653836
Name:ROBERTS, SANDRA LEE (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59749-9600
Mailing Address - Country:US
Mailing Address - Phone:074-592-4001
Mailing Address - Fax:
Practice Address - Street 1:310 S ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-9201
Practice Address - Country:US
Practice Address - Phone:407-592-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1571022363LF0000X
MTNUR-RN-LIC 49096363LF0000X
AK903363LF0000X
WAAP61044272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily