Provider Demographics
NPI:1073912747
Name:FLEMING, SANDRA LOUISE (STNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOUISE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4067 E 142ND ST
Mailing Address - Street 2:UP
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1859
Mailing Address - Country:US
Mailing Address - Phone:216-410-9091
Mailing Address - Fax:
Practice Address - Street 1:4067 E 142ND ST
Practice Address - Street 2:UP
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1859
Practice Address - Country:US
Practice Address - Phone:216-410-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400357290504376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide