Provider Demographics
NPI:1114411295
Name:POLLARD, SANDRA (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:62178 TICONDEROGA DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1075
Mailing Address - Country:US
Mailing Address - Phone:734-904-2568
Mailing Address - Fax:
Practice Address - Street 1:5525 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3546
Practice Address - Country:US
Practice Address - Phone:517-913-3888
Practice Address - Fax:517-394-7483
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704161852363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner