Provider Demographics
NPI:1184378879
Name:GOOD, SANDRA LYNNE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNNE
Last Name:GOOD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:LANDIS
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:135 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9621
Mailing Address - Country:US
Mailing Address - Phone:717-757-4614
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2207
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily