Provider Demographics
NPI:1437493111
Name:HORNING, SANDRA A (LPN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:HORNING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21107 COFFEEN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-782-9285
Mailing Address - Fax:
Practice Address - Street 1:21107 COFFEEN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281331-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse