Provider Demographics
NPI:1396824892
Name:CHETNIK-NORRIS, SANDRA CONSTANCE (RN ANP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CONSTANCE
Last Name:CHETNIK-NORRIS
Suffix:
Gender:F
Credentials:RN ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17469 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1147
Mailing Address - Country:US
Mailing Address - Phone:216-299-7313
Mailing Address - Fax:
Practice Address - Street 1:2503 RUBYVALE RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4619
Practice Address - Country:US
Practice Address - Phone:216-406-4323
Practice Address - Fax:216-291-9861
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 143229163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q15217Medicare UPIN