Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 37676 | AZ |
Y | 208600000X | Surgeon | 37676 | AZ |
N | 2082S0105X | Plastic Hand Surgeon | 37676 | AZ |
NPI | 1770690463 |
---|---|
Provider Name | Sven Nicklas Sandeen |
First Address | Tucson, AZ 85741-2306 |
Second Address | Tucson, AZ 85741-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 05/01/2016 |