Provider Demographics
NPI:1790496792
Name:HADLEY, SANDY LEA (LE)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:LEA
Last Name:HADLEY
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E CHOCTAW AVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-3109
Mailing Address - Country:US
Mailing Address - Phone:918-273-8533
Mailing Address - Fax:
Practice Address - Street 1:114 W DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-2601
Practice Address - Country:US
Practice Address - Phone:918-625-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK$$$$$$$$$374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide