Provider Demographics
NPI:1093998296
Name:WEILAND, SANDRA ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANN
Last Name:WEILAND
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 1:102 NORTH CHOCTAW STREET
Mailing Address - Street 2:
Mailing Address - City:WAPANUCKA
Mailing Address - State:OK
Mailing Address - Zip Code:73461
Mailing Address - Country:US
Mailing Address - Phone:580-937-9900
Mailing Address - Fax:
Practice Address - Street 1:102 NORTH CHOCTAW
Practice Address - Street 2:
Practice Address - City:WAPANUCKA
Practice Address - State:OK
Practice Address - Zip Code:73461
Practice Address - Country:US
Practice Address - Phone:580-428-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0060869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200046190AMedicaid
OK244509008Medicare PIN