Provider Demographics
NPI:1275599912
Name:MENKEDICK, SANDRA K (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:MENKEDICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 ALBERT SABIN WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-2827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:859-426-4051
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-475-8690
Practice Address - Fax:513-475-7257
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3591P363L00000X
OH06618164W00000X
OHAPRNCNP06618363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2364365Medicaid
P59519Medicare UPIN
OHMENP10411Medicare UPIN
KY0551837Medicare PIN