Provider Demographics
NPI:1609284686
Name:KINSEL, SANDRA K
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:KINSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 GARDENIA DR
Mailing Address - Street 2:
Mailing Address - City:W CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2914
Mailing Address - Country:US
Mailing Address - Phone:937-414-4156
Mailing Address - Fax:
Practice Address - Street 1:3214 GARDENIA DR
Practice Address - Street 2:
Practice Address - City:W CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2914
Practice Address - Country:US
Practice Address - Phone:937-414-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143436164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse