Provider Demographics
NPI:1093118929
Name:ADRIAN, SANDY (LVN)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:ADRIAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 FOX PL
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4486
Mailing Address - Country:US
Mailing Address - Phone:830-965-6667
Mailing Address - Fax:
Practice Address - Street 1:2637 FOX PL
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4486
Practice Address - Country:US
Practice Address - Phone:830-965-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316919164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse