Provider Demographics
NPI:1437168622
Name:SCHOLEBO, SANDRA ELAINE (RN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELAINE
Last Name:SCHOLEBO
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 LANCER ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4488
Mailing Address - Country:US
Mailing Address - Phone:219-764-3600
Mailing Address - Fax:219-764-3661
Practice Address - Street 1:3190 LANCER ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368
Practice Address - Country:US
Practice Address - Phone:219-764-3600
Practice Address - Fax:219-764-3661
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily