| Doctor Name: | MS. SANDRA ELAINE FORTENBERRY |
| NPI Number: | 1104000488 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, FNP-BC |
| License Number: | RN044563 |
| Business Practice Address: | 224 E Butler Rd Cvs/minuteclinic Mauldin, SC - 296622129 |
| Business Phone Number: | 7709383842 |
| Business Fax Number: | |
| Mailing Address: | 4006 Arborwood Ln, TUCKER |
| State: | GA |
| Postal Code: | 300845521 |
| Phone Number: | 7709383842 |
| Fax Number: | |
| NPI Enumeration Date: | 12/22/2007 |
| NPI Last Update Date: | 09/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP2201X |
| License Number: | RN044563 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Ambulatory Care |
| Taxonomy Definition: | |