Provider Demographics
NPI:1427008085
Name:GILBERTSON, SANDRA (PNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2977
Mailing Address - Country:US
Mailing Address - Phone:816-271-4022
Mailing Address - Fax:816-271-4020
Practice Address - Street 1:711 N 36TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2977
Practice Address - Country:US
Practice Address - Phone:816-271-4022
Practice Address - Fax:816-271-4020
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428290316Medicaid
MO1710186671Medicaid
MOP00688411OtherRR MEDICARE
KS200477790BMedicaid
MOF2B347AMedicare PIN
P40532Medicare UPIN
MO428290316Medicaid