Provider Demographics
NPI:1790820892
Name:GREENSPAN, SANDRA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:GREENSPAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:29600 S WIXOM RD
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3430
Mailing Address - Country:US
Mailing Address - Phone:248-926-8459
Mailing Address - Fax:248-926-1310
Practice Address - Street 1:29600 S WIXOM RD
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3430
Practice Address - Country:US
Practice Address - Phone:248-926-8459
Practice Address - Fax:248-926-1310
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant