Provider Demographics
NPI:1811588031
Name:LARIBO, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LARIBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:LARIBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CONNECTUS
Mailing Address - Street 1:618 FOSTER LN
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3198
Mailing Address - Country:US
Mailing Address - Phone:843-364-5681
Mailing Address - Fax:
Practice Address - Street 1:618 FOSTER LN
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3198
Practice Address - Country:US
Practice Address - Phone:843-364-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor