Provider Demographics
NPI:1619165727
Name:MEAD, SANDRA ANN (APN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANN
Last Name:MEAD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 CLEVELAND CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1707
Mailing Address - Country:US
Mailing Address - Phone:732-864-6748
Mailing Address - Fax:
Practice Address - Street 1:1516 HWY 138
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3700
Practice Address - Country:US
Practice Address - Phone:732-681-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00026200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse