Basic Information
| Provider Information | |||||||||
| NPI: | 1699050492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDEMAN | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | FITZGERALD | ||||||||
| NamePrefix: | |||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 ATWATER ST N OFC | ||||||||
| Address2: | |||||||||
| City: | MONMOUTH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973611801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033787526 | ||||||||
| FaxNumber: | 5035854278 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 ATWATER ST N OFC | ||||||||
| Address2: | |||||||||
| City: | MONMOUTH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033787526 | ||||||||
| FaxNumber: | 5035854278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2011 | ||||||||
| LastUpdateDate: | 10/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 21378 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.