Provider Demographics
NPI:1558363879
Name:BOLLIER, SANDRA DEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DEE
Last Name:BOLLIER
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 1:3811 N US HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2580
Mailing Address - Country:US
Mailing Address - Phone:903-487-0477
Mailing Address - Fax:903-892-9724
Practice Address - Street 1:3811 N US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2580
Practice Address - Country:US
Practice Address - Phone:903-487-0477
Practice Address - Fax:903-892-9724
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629331363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7419Medicare ID - Type Unspecified
TXP37862Medicare UPIN