Provider Demographics
NPI:1346011384
Name:WACHTEL, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WACHTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:FESSENDEN
Mailing Address - State:ND
Mailing Address - Zip Code:58438-7413
Mailing Address - Country:US
Mailing Address - Phone:701-650-1830
Mailing Address - Fax:
Practice Address - Street 1:1211 2ND ST NE
Practice Address - Street 2:
Practice Address - City:FESSENDEN
Practice Address - State:ND
Practice Address - Zip Code:58438-7413
Practice Address - Country:US
Practice Address - Phone:701-650-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant