Provider Demographics
NPI:1669448106
Name:COLT, SANDRA B (GNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:COLT
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6606
Mailing Address - Country:US
Mailing Address - Phone:207-622-6226
Mailing Address - Fax:
Practice Address - Street 1:40 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6606
Practice Address - Country:US
Practice Address - Phone:207-622-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER039267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312560099Medicaid
ME312560099Medicaid
ME500008237Medicare PIN
MES38215Medicare UPIN