Provider Demographics
NPI:1720061765
Name:MATHIEU, SANDRA ANN (RN-CS FNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANN
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:RN-CS FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SMITHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3474
Mailing Address - Country:US
Mailing Address - Phone:401-725-0900
Mailing Address - Fax:
Practice Address - Street 1:100 SMITHFIELD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3474
Practice Address - Country:US
Practice Address - Phone:401-725-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP31617163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP80070Medicare UPIN