Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 20915 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704336431 | MI |
NPI | 1003197583 |
---|---|
Provider Name | Mrs. Sandra Leanne Handysides |
First Address | Traverse City, MI 49685-9094 |
Second Address | Peshawbestown, MI 49682-9158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2011 |
Last Update Date | 12/02/2020 |