Provider Demographics
NPI:1558503300
Name:EDOBOR, SANDRA EKATA (LVN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:EKATA
Last Name:EDOBOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250863
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0863
Mailing Address - Country:US
Mailing Address - Phone:214-501-4750
Mailing Address - Fax:214-501-4750
Practice Address - Street 1:5451 INDEPENDENCE PKWY APT 2506
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5440
Practice Address - Country:US
Practice Address - Phone:214-501-4750
Practice Address - Fax:214-501-4750
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174803164X00000X
CA187679164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse