Provider Demographics
NPI:1497035448
Name:LODER, SANDRA SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SUE
Last Name:LODER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1027
Mailing Address - Country:US
Mailing Address - Phone:716-968-4394
Mailing Address - Fax:
Practice Address - Street 1:237 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1027
Practice Address - Country:US
Practice Address - Phone:716-968-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3008181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse