Provider Demographics
NPI:1710941349
Name:MCMICHAEL, SANDRA L (CRNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 VALLEYDALE RD STE C
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2075
Mailing Address - Country:US
Mailing Address - Phone:205-769-6300
Mailing Address - Fax:205-769-6302
Practice Address - Street 1:2649 VALLEYDALE RD STE C
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2075
Practice Address - Country:US
Practice Address - Phone:205-769-6300
Practice Address - Fax:205-769-6302
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1054167363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051526461Medicaid
ALQ39047Medicare UPIN
AL051526461Medicaid