Provider Demographics
NPI:1588827786
Name:LAW, SANDRA LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:LAW
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 1:47 EATON AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1725
Mailing Address - Country:US
Mailing Address - Phone:607-316-2583
Mailing Address - Fax:607-674-4338
Practice Address - Street 1:47 EATON AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1725
Practice Address - Country:US
Practice Address - Phone:607-316-2583
Practice Address - Fax:607-674-4338
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288624-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse