Provider Demographics
NPI:1598952533
Name:ROYSTON, SALLY ANNE (RN,MSN,FNP-C)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANNE
Last Name:ROYSTON
Suffix:
Gender:F
Credentials:RN,MSN,FNP-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1031 PIERCE ST
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4669
Mailing Address - Country:US
Mailing Address - Phone:419-557-5568
Mailing Address - Fax:419-557-5542
Practice Address - Street 1:292 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2374
Practice Address - Country:US
Practice Address - Phone:419-663-3737
Practice Address - Fax:419-663-5096
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2016-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN201627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068732Medicaid
OHH365800Medicare PIN