Provider Demographics
NPI:1366607442
Name:NUNLEY, SANDRA L (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:NUNLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:809 GALLAGHER DR STE B
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1754
Mailing Address - Country:US
Mailing Address - Phone:903-957-0302
Mailing Address - Fax:903-893-6762
Practice Address - Street 1:809 GALLAGHER DR STE B
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1754
Practice Address - Country:US
Practice Address - Phone:903-957-0302
Practice Address - Fax:903-893-6762
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531595363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285175YKP5Medicare PIN