Provider Demographics
NPI:1952837858
Name:ODA, SANDRA MAY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MAY
Last Name:ODA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 COUNTY ROAD 52
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9659
Mailing Address - Country:US
Mailing Address - Phone:260-925-5278
Mailing Address - Fax:
Practice Address - Street 1:3552 COUNTY ROAD 52
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-9659
Practice Address - Country:US
Practice Address - Phone:260-925-5278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28096877A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily