Provider Demographics
NPI:1225377666
Name:HATHAWAY, SANDRA LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LOUISE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:DE RUYTER
Mailing Address - State:NY
Mailing Address - Zip Code:13052-9700
Mailing Address - Country:US
Mailing Address - Phone:315-852-3400
Mailing Address - Fax:315-852-9600
Practice Address - Street 1:711 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:DE RUYTER
Practice Address - State:NY
Practice Address - Zip Code:13052-9700
Practice Address - Country:US
Practice Address - Phone:315-852-3400
Practice Address - Fax:315-852-9600
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY512628163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool