Provider Demographics
NPI:1417291642
Name:RUE, SANDRA L (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:RUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2694 LANTZ RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6627
Mailing Address - Country:US
Mailing Address - Phone:937-705-6023
Mailing Address - Fax:
Practice Address - Street 1:2694 LANTZ RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6627
Practice Address - Country:US
Practice Address - Phone:937-705-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.365363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse