Provider Demographics
NPI:1316039415
Name:CLOSSER, SANDRA KAY (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:CLOSSER
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MONTGOMERY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2697
Mailing Address - Country:US
Mailing Address - Phone:513-487-5305
Mailing Address - Fax:513-487-5317
Practice Address - Street 1:4435 AICHOLTZ RD
Practice Address - Street 2:STE 800C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1690
Practice Address - Country:US
Practice Address - Phone:513-688-1500
Practice Address - Fax:513-753-2472
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09010363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health