Provider Demographics
NPI:1437111606
Name:MOTE, SANDRA LA REE (MS CS ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LA REE
Last Name:MOTE
Suffix:
Gender:F
Credentials:MS CS ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-9200
Mailing Address - Fax:603-742-4605
Practice Address - Street 1:10 MEMBERS WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-742-9200
Practice Address - Fax:603-742-4605
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH589163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074048Medicaid
7135879OtherAETNA
NH2023607OtherCIGNA
NH4009533YONH01OtherBCBS
NH3074048Medicaid
NH4009533YONH01OtherBCBS