Provider Demographics
NPI:1003172305
Name:HARSHAW, SANDRA KAY (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:HARSHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-0846
Mailing Address - Country:US
Mailing Address - Phone:719-836-4149
Mailing Address - Fax:719-836-3433
Practice Address - Street 1:899 STEINFELT PARKWAY
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440
Practice Address - Country:US
Practice Address - Phone:719-836-4149
Practice Address - Fax:719-836-3433
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO198906163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse