Provider Demographics
NPI:1962006577
Name:NUSSBAUM, SONDRA MICHELLE
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:MICHELLE
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5293 KISTER RD
Mailing Address - Street 2:
Mailing Address - City:SHREVE
Mailing Address - State:OH
Mailing Address - Zip Code:44676-9522
Mailing Address - Country:US
Mailing Address - Phone:330-317-6060
Mailing Address - Fax:
Practice Address - Street 1:5293 KISTER RD
Practice Address - Street 2:
Practice Address - City:SHREVE
Practice Address - State:OH
Practice Address - Zip Code:44676-9522
Practice Address - Country:US
Practice Address - Phone:330-317-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide