Provider Demographics
NPI:1417380643
Name:THAO, SANDY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:ANN
Last Name:THAO
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 1:6186 E LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5647
Mailing Address - Country:US
Mailing Address - Phone:559-313-0515
Mailing Address - Fax:
Practice Address - Street 1:6186 E LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-5647
Practice Address - Country:US
Practice Address - Phone:559-313-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA798950163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse