Provider Demographics
NPI:1902862923
Name:ALTENBACH, SANDRA MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIE
Last Name:ALTENBACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HIGHLAND DRIVE
Mailing Address - Street 2:COMMUNITY MEDICAL CARE
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-889-0433
Mailing Address - Fax:276-889-5537
Practice Address - Street 1:17786 US HWAY 19
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:VA
Practice Address - Zip Code:24280
Practice Address - Country:US
Practice Address - Phone:276-880-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily