Provider Demographics
NPI:1598905564
Name:SANDELSKI, MARY K (RNC, CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:SANDELSKI
Suffix:
Gender:F
Credentials:RNC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 397
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-0397
Mailing Address - Country:US
Mailing Address - Phone:317-637-4343
Mailing Address - Fax:
Practice Address - Street 1:2803 BOILERMAKER CT.
Practice Address - Street 2:SUITE 1-F
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-462-5976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28105682A163W00000X
IN09000073A176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife