Provider Demographics
NPI:1730495524
Name:WILEY, SANDRA KAY (BSN, CCP, LP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:WILEY
Suffix:
Gender:F
Credentials:BSN, CCP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 OTTAWA RUN
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1455
Mailing Address - Country:US
Mailing Address - Phone:210-493-7379
Mailing Address - Fax:210-493-9567
Practice Address - Street 1:102 OTTAWA RUN
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1455
Practice Address - Country:US
Practice Address - Phone:210-493-7379
Practice Address - Fax:210-493-9567
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX224548163W00000X
TXPF0138242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No163W00000XNursing Service ProvidersRegistered Nurse