Provider Demographics
NPI:1720407885
Name:BANFILL, SANDRA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:BANFILL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17779
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-0779
Mailing Address - Country:US
Mailing Address - Phone:602-374-7522
Mailing Address - Fax:602-237-6997
Practice Address - Street 1:2700 N 3RD ST STE 3045
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4627
Practice Address - Country:US
Practice Address - Phone:602-374-7522
Practice Address - Fax:602-237-6997
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5510363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care