Provider Demographics
NPI:1942822929
Name:PABST, SANDRA THERESA (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:THERESA
Last Name:PABST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TECUMSEH WAY
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2870
Mailing Address - Country:US
Mailing Address - Phone:443-756-9999
Mailing Address - Fax:
Practice Address - Street 1:305 TECUMSEH WAY
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2870
Practice Address - Country:US
Practice Address - Phone:443-756-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR060225163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR060225OtherRN