Provider Demographics
NPI:1003214644
Name:MOREO, SANDRA KAY (LPN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:MOREO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:CONTINENTAL
Mailing Address - State:OH
Mailing Address - Zip Code:45831-8952
Mailing Address - Country:US
Mailing Address - Phone:419-969-0685
Mailing Address - Fax:
Practice Address - Street 1:207 N RIVER ST
Practice Address - Street 2:
Practice Address - City:CONTINENTAL
Practice Address - State:OH
Practice Address - Zip Code:45831-8952
Practice Address - Country:US
Practice Address - Phone:419-969-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.139149-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN.139149-M-IVMedicaid