Provider Demographics
NPI:1528565843
Name:KAUTZ, SANDRA KAY (LPN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:KAUTZ
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 1:177 TEMPLETON TER
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1134
Mailing Address - Country:US
Mailing Address - Phone:419-884-7172
Mailing Address - Fax:
Practice Address - Street 1:103 CLEVER LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1269
Practice Address - Country:US
Practice Address - Phone:419-888-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081473164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse