Provider Demographics
NPI:1396783908
Name:MELLOR, SANDRA MARIE (DNP, APPN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:MELLOR
Suffix:
Gender:F
Credentials:DNP, APPN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 E 61ST ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1908
Mailing Address - Country:US
Mailing Address - Phone:918-893-3535
Mailing Address - Fax:918-893-3570
Practice Address - Street 1:8316 E 61ST ST STE 101A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1908
Practice Address - Country:US
Practice Address - Phone:918-893-3535
Practice Address - Fax:918-893-3570
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88750363LA2200X, 363LF0000X
TX653337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200623310AMedicaid