Provider Demographics
NPI:1043568850
Name:HILL OLDS, SANDRA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:HILL OLDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3323
Mailing Address - Country:US
Mailing Address - Phone:718-774-8262
Mailing Address - Fax:718-774-8262
Practice Address - Street 1:317 E 48TH ST
Practice Address - Street 2:2R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3323
Practice Address - Country:US
Practice Address - Phone:718-774-8262
Practice Address - Fax:718-774-8262
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270901-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY164W00000XMedicaid