Provider Demographics
NPI:1558681999
Name:SANDERS, OLGA SMITH (LPN)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:SMITH
Last Name:SANDERS
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 1:154 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1311
Mailing Address - Country:US
Mailing Address - Phone:516-234-1929
Mailing Address - Fax:
Practice Address - Street 1:154 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1311
Practice Address - Country:US
Practice Address - Phone:516-234-1929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265417-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse