Provider Demographics
NPI:1508593385
Name:SANDUSKY, DANA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:SANDUSKY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2030
Mailing Address - Country:US
Mailing Address - Phone:816-261-2558
Mailing Address - Fax:
Practice Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3069
Practice Address - Country:US
Practice Address - Phone:888-256-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022020130363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner