Provider Demographics
NPI:1407817661
Name:KORDIS-RUBIN, SANDRA L (C-NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:KORDIS-RUBIN
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:KORDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 OLD BANK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2443
Mailing Address - Country:US
Mailing Address - Phone:513-683-5700
Mailing Address - Fax:513-683-5701
Practice Address - Street 1:201 OLD BANK RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2416
Practice Address - Country:US
Practice Address - Phone:513-248-0100
Practice Address - Fax:513-248-4334
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.06675-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584001Medicaid
OH2584001Medicaid