Provider Demographics
NPI:1215472253
Name:SANDOVAL, JONI MICHELLE
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:MICHELLE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WEST FRANCIS ST. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3711
Mailing Address - Country:US
Mailing Address - Phone:308-534-2532
Mailing Address - Fax:
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0620
Practice Address - Country:US
Practice Address - Phone:308-520-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112165363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily