Provider Demographics
NPI:1114911864
Name:CRUICKSHANK, SANDRA DAYLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:DAYLE
Last Name:CRUICKSHANK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DAYLE
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:100 WEST WICKS LANE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1539
Mailing Address - Country:US
Mailing Address - Phone:406-294-8643
Mailing Address - Fax:
Practice Address - Street 1:100 WEST WICKS LANE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1539
Practice Address - Country:US
Practice Address - Phone:406-294-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR RN LIC 8033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4300595Medicaid
MT4300595Medicaid
MT83549Medicare UPIN