Provider Demographics
NPI:1063305399
Name:REISS, SANDRA ANN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:REISS
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 1:4216 N ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-7831
Mailing Address - Country:US
Mailing Address - Phone:701-400-8595
Mailing Address - Fax:
Practice Address - Street 1:4216 N ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-7831
Practice Address - Country:US
Practice Address - Phone:701-400-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker