Provider Demographics
NPI:1710930912
Name:SAND, VIRGINIA L
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:SAND
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 1:3731 GOOSE LN
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9668
Mailing Address - Country:US
Mailing Address - Phone:740-587-3404
Mailing Address - Fax:
Practice Address - Street 1:6520 W CAMPUS OVAL
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8726
Practice Address - Country:US
Practice Address - Phone:614-413-2233
Practice Address - Fax:614-413-2234
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN254210367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000385794OtherANTHEM
OH0996098Medicaid