Provider Demographics
NPI:1679524763
Name:QUATTLEBAUM, SANDRA CHRISTINE (MS, RN, CNS, ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:CHRISTINE
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:MS, RN, CNS, ACNP-BC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:CHRISTINE
Other - Last Name:ROWLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43336 LAGO BREEZA DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2960
Mailing Address - Country:US
Mailing Address - Phone:916-284-3848
Mailing Address - Fax:
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-323-6614
Practice Address - Fax:760-323-6347
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470424/10336363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10336OtherNP CERTIFICATE NUMBER
CA470424OtherRN LICENSE NUMBER