Provider Demographics
NPI:1528034592
Name:PICARD, SANDRA J (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:PICARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 READFIELD UNIT 558
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-0558
Mailing Address - Country:US
Mailing Address - Phone:207-512-8780
Mailing Address - Fax:207-623-3137
Practice Address - Street 1:8 POND RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3615
Practice Address - Country:US
Practice Address - Phone:207-512-8780
Practice Address - Fax:207-623-3137
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME241890099Medicaid
MENP2832Medicare PIN
ME283207Medicare PIN
ME283204Medicare Oscar/Certification
ME283202Medicare Oscar/Certification
ME241890099Medicaid
ME283202Medicare PIN
MEP17414Medicare UPIN
ME283207Medicare Oscar/Certification
MENP283201Medicare PIN
ME283203Medicare PIN
ME500027560Medicare PIN
ME283210Medicare PIN
ME283201Medicare PIN
ME283201Medicare Oscar/Certification
ME283205Medicare Oscar/Certification
ME283205Medicare PIN
ME283204Medicare PIN
ME283211Medicare PIN
METX6443Medicare PIN