Provider Demographics
NPI:1710937016
Name:LAIRD, SANDRA (RN, ACNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LAIRD
Suffix:
Gender:F
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 WEST GREEN OAKS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016
Mailing Address - Country:US
Mailing Address - Phone:817-496-1919
Mailing Address - Fax:817-496-6133
Practice Address - Street 1:3921 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2764
Practice Address - Country:US
Practice Address - Phone:817-496-1919
Practice Address - Fax:817-496-6133
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567095363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1167991-03Medicaid
TX1167991-02Medicaid
TXS35393Medicare UPIN
TX1167991-03Medicaid
TX83N650Medicare PIN