Provider Demographics
NPI:1235622689
Name:LINEN, SANDRA (LPN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:LINEN
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 1:131 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2832
Mailing Address - Country:US
Mailing Address - Phone:315-797-1115
Mailing Address - Fax:
Practice Address - Street 1:131 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2832
Practice Address - Country:US
Practice Address - Phone:315-797-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268997-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse