Provider Demographics
NPI:1659575157
Name:VOLLMER-SANDHOLM, MARY JOANNE (MSN, PNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOANNE
Last Name:VOLLMER-SANDHOLM
Suffix:
Gender:F
Credentials:MSN, PNP
Other - Prefix:MRS
Other - First Name:MARY JO
Other - Middle Name:
Other - Last Name:SANDHOLM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, PNP
Mailing Address - Street 1:LOMA LINDA UNIVERSITY SCHOOL OF NURSING
Mailing Address - Street 2:11262 CAMPUS ST.
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-1000
Mailing Address - Fax:
Practice Address - Street 1:LOMA LINDA UNIVERSITY SCHOOL OF NURSING
Practice Address - Street 2:11262 CAMPUS ST.
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533452363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11930OtherNURSE PRACTITIONER CERT
CA533452OtherRN
CA11930OtherFURNISHING