Provider Demographics
NPI:1679973903
Name:GOLLES, SANDRA LEE (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:GOLLES
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Gender:F
Credentials:NP
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Mailing Address - Street 1:1145 WHISKEYTOWN CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0227
Mailing Address - Country:US
Mailing Address - Phone:530-246-4180
Mailing Address - Fax:530-242-6421
Practice Address - Street 1:1145 WHISKEYTOWN CT
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0227
Practice Address - Country:US
Practice Address - Phone:530-246-4180
Practice Address - Fax:530-242-6421
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP4046363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics