Provider Demographics
NPI:1790716033
Name:KNOWLES, SANDRA LEE (DNP, APRN, BC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:DNP, APRN, BC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:881 W. STATE STREET
Mailing Address - Street 2:SUITE 140-429
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-6200
Mailing Address - Country:US
Mailing Address - Phone:801-615-0699
Mailing Address - Fax:801-367-7678
Practice Address - Street 1:881 W. STATE STREET
Practice Address - Street 2:SUITE 140-429
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-6200
Practice Address - Country:US
Practice Address - Phone:801-615-0699
Practice Address - Fax:801-367-7678
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49008288900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005778204Medicare ID - Type Unspecified