Provider Demographics
NPI:1497518690
Name:STANSELL, SANDRA KATHERINE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KATHERINE
Last Name:STANSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:STANSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:85 SMITH ST APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1884
Mailing Address - Country:US
Mailing Address - Phone:843-694-1772
Mailing Address - Fax:
Practice Address - Street 1:85 SMITH ST APT A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1884
Practice Address - Country:US
Practice Address - Phone:843-694-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant