Provider Demographics
NPI:1780790311
Name:SLATER, SANDRA JEAN (APN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JEAN
Last Name:SLATER
Suffix:
Gender:F
Credentials:APN
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Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:CLINIC 11
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:180-084-9359
Mailing Address - Fax:214-462-4958
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:CLINIC 11
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:180-084-9359
Practice Address - Fax:214-462-4958
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX445505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily