Provider Demographics
NPI:1083857999
Name:FALES, SANDRA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:FALES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:LOLLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:303 PARK AVE
Mailing Address - City:PORTER
Mailing Address - State:MN
Mailing Address - Zip Code:56280-0001
Mailing Address - Country:US
Mailing Address - Phone:507-401-6280
Mailing Address - Fax:
Practice Address - Street 1:106 N 4TH AVE # NORTH
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0616119164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse