Provider Demographics
NPI:1689190431
Name:EDPAO, SANDRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:EDPAO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5120
Mailing Address - Country:US
Mailing Address - Phone:877-828-4510
Mailing Address - Fax:
Practice Address - Street 1:210 9TH AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5120
Practice Address - Country:US
Practice Address - Phone:877-828-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007141363LF0000X
WAAP60824785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily