Provider Demographics
NPI:1780291732
Name:NELSON, SANDRA KAYE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAYE
Last Name:NELSON
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 1:1815 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2223
Mailing Address - Country:US
Mailing Address - Phone:513-594-5256
Mailing Address - Fax:
Practice Address - Street 1:1815 HENRY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2223
Practice Address - Country:US
Practice Address - Phone:513-594-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide