Provider Demographics
NPI:1356661979
Name:MCKISSIC, SAUNDRA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SAUNDRA
Middle Name:LYNN
Last Name:MCKISSIC
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 1:1419 PENN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3049
Mailing Address - Country:US
Mailing Address - Phone:612-522-5232
Mailing Address - Fax:612-522-5232
Practice Address - Street 1:1419 PENN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3049
Practice Address - Country:US
Practice Address - Phone:612-522-5232
Practice Address - Fax:612-522-5232
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 67360-2374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula