Provider Demographics
NPI:1275006942
Name:PRINCE, SANDRA ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELLEN
Last Name:PRINCE
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:W174N10192 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6412
Mailing Address - Country:US
Mailing Address - Phone:262-527-6946
Mailing Address - Fax:
Practice Address - Street 1:W174N10192 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6412
Practice Address - Country:US
Practice Address - Phone:262-527-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care