Provider Demographics
NPI:1427127380
Name:KLUG, SANDRA A (GNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:KLUG
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 BOONE STATION DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9775
Mailing Address - Country:US
Mailing Address - Phone:336-586-9850
Mailing Address - Fax:
Practice Address - Street 1:791 BOONE STATION DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9775
Practice Address - Country:US
Practice Address - Phone:336-586-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2591298Medicare ID - Type Unspecified
NCP32769Medicare UPIN