Provider Demographics
NPI:1356340103
Name:WILBANKS, SANDRA KAY (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:WILBANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-692-7000
Mailing Address - Fax:989-695-2757
Practice Address - Street 1:7362 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8803
Practice Address - Country:US
Practice Address - Phone:989-692-7000
Practice Address - Fax:989-695-2757
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704130169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396850418Medicaid
MI1396850418Medicaid
MIP00399674Medicare PIN
MI0N98270003Medicare PIN