Doctor Name: | JOSEPH EDWARD SANDUSKY |
NPI Number: | 1548547359 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP-C |
License Number: | 5005376 |
Business Practice Address: | 402 West King Street King, NC - 27021 |
Business Phone Number: | 3369839617 |
Business Fax Number: | |
Mailing Address: | 402 West King Street, KING |
State: | NC |
Postal Code: | 27021 |
Phone Number: | 3369839617 |
Fax Number: | |
NPI Enumeration Date: | 11/08/2011 |
NPI Last Update Date: | 11/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5005376 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |