Provider Demographics
NPI:1912296211
Name:ULMER, SANDRA LOUISE (DNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LOUISE
Last Name:ULMER
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2981 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7007
Mailing Address - Country:US
Mailing Address - Phone:615-429-2748
Mailing Address - Fax:
Practice Address - Street 1:1840 MESQUITE AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5771
Practice Address - Country:US
Practice Address - Phone:928-453-8500
Practice Address - Fax:928-854-4229
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN15710363LF0000X
AZ4136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ627947Medicaid
AZZ146927Medicare Oscar/Certification