Provider Demographics
NPI:1649677998
Name:STEPHENS, SANDRA LEE (RN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19326 BOTHELL EVERETT HWY
Mailing Address - Street 2:SP #23
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7145
Mailing Address - Country:US
Mailing Address - Phone:425-485-2356
Mailing Address - Fax:
Practice Address - Street 1:19326 BOTHELL EVERETT HWY
Practice Address - Street 2:SP #23
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7145
Practice Address - Country:US
Practice Address - Phone:425-485-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00094442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse