Doctor Name: | SANDRA BOAFOA ANIM |
NPI Number: | 1821422320 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 041392010 |
Business Practice Address: | 2323 Texas St Pecos, TX - 797727338 |
Business Phone Number: | 4324470565 |
Business Fax Number: | 4324470422 |
Mailing Address: | 2323 Texas St, PECOS |
State: | TX |
Postal Code: | 797727338 |
Phone Number: | 4324470565 |
Fax Number: | 4324470422 |
NPI Enumeration Date: | 09/03/2013 |
NPI Last Update Date: | 09/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SF0001X |
License Number: | 041392010 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Family Health |
Taxonomy Definition: |