Provider Demographics
NPI:1255306551
Name:SHUMAKER, SANDRA LOUISE (ACNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOUISE
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SPYGLASS CIR
Mailing Address - Street 2:CNOS, PC
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5101
Mailing Address - Country:US
Mailing Address - Phone:712-490-8422
Mailing Address - Fax:
Practice Address - Street 1:921 SPYGLASS CIR
Practice Address - Street 2:CNOS, PC
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5101
Practice Address - Country:US
Practice Address - Phone:712-490-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000461363LA2100X
IAL113973363LA2100X
NE111169363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P98216Medicare UPIN
SD100973Medicare PIN
IAI17680Medicare PIN