Provider Demographics
NPI:1790930238
Name:MORRIS, SANDRA LEE (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:ROSELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 SE MARION AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2039
Mailing Address - Country:US
Mailing Address - Phone:541-753-8077
Mailing Address - Fax:
Practice Address - Street 1:945 SE MARION AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2039
Practice Address - Country:US
Practice Address - Phone:541-753-8077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088000299RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse