Provider Demographics
NPI:1922277326
Name:HOLTON, SANDRA L (RN,CDE)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:HOLTON
Suffix:
Gender:F
Credentials:RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E MARSHALL AVE STE 1001
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5500
Mailing Address - Country:US
Mailing Address - Phone:903-753-7291
Mailing Address - Fax:903-315-5000
Practice Address - Street 1:703 E MARSHALL AVE STE 1001
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-753-7291
Practice Address - Fax:903-315-5000
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX447016163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX447016OtherTEXAS BOARD OF NURSING