Provider Demographics
NPI:1558494856
Name:ADERHOLD, SANDRA (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ADERHOLD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 DAVID CT
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-2757
Mailing Address - Country:US
Mailing Address - Phone:301-714-4041
Mailing Address - Fax:301-714-4351
Practice Address - Street 1:1110 MEDICAL CAMPUS ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-714-4041
Practice Address - Fax:301-714-4351
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175330163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator