Provider Demographics
NPI:1013551019
Name:MEDEIROS, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MEDEIROS
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:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-1510
Mailing Address - Country:US
Mailing Address - Phone:775-945-2461
Mailing Address - Fax:775-945-0721
Practice Address - Street 1:200 SOUTH A STREET
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-1510
Practice Address - Country:US
Practice Address - Phone:775-945-2461
Practice Address - Fax:775-945-0721
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2024-01-23
Deactivation Date:2020-09-24
Deactivation Code:
Reactivation Date:2021-06-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker