Provider Demographics
NPI:1376836585
Name:ABBOTT, SANDRA DARLENE
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:DARLENE
Last Name:ABBOTT
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 1:22288 GLENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5236
Mailing Address - Country:US
Mailing Address - Phone:734-692-2485
Mailing Address - Fax:
Practice Address - Street 1:22288 GLENWOOD LN
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-5236
Practice Address - Country:US
Practice Address - Phone:734-692-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator