Provider Demographics
NPI:1972567691
Name:MCGRATH, SANDRA E (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E REELFOOT AVE
Mailing Address - Street 2:STE 202 A
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6047
Mailing Address - Country:US
Mailing Address - Phone:731-885-3866
Mailing Address - Fax:731-885-3868
Practice Address - Street 1:1720 E REELFOOT AVE
Practice Address - Street 2:STE 202 A
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6047
Practice Address - Country:US
Practice Address - Phone:731-885-3866
Practice Address - Fax:731-885-3868
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1607363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN150373Medicaid
TN200448096OtherFEDRERAL TAX ID
TN9523Medicaid
TN4075871OtherBLUE CROSS BLUE SHIELD
TN9523Medicaid
TN150373Medicaid