Provider Demographics
NPI:1104885508
Name:MCGAUGHEY, SANDRA L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:MCGAUGHEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCCANNEL HALL ROOM 100
Mailing Address - Street 2:2891 2ND AVENUE NORTH STOP 9038
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9038
Mailing Address - Country:US
Mailing Address - Phone:701-777-4500
Mailing Address - Fax:
Practice Address - Street 1:MCCANNEL HALL ROOM 100
Practice Address - Street 2:2891 2ND AVENUE NORTH STOP 9038
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9038
Practice Address - Country:US
Practice Address - Phone:701-777-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10300Medicaid
NDS03880Medicare UPIN
ND21884Medicare ID - Type Unspecified