Provider Demographics
NPI:1174650758
Name:SAMMUT, SANDRA DIANE (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DIANE
Last Name:SAMMUT
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 1:1145 WHISKEYTOWN COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-222-3856
Mailing Address - Fax:
Practice Address - Street 1:1145 WHISKEYTOWN COURT, SUITE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-242-6821
Practice Address - Fax:530-242-6421
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN607935363LF0000X
CA607935(LICENSE)15204363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily