Provider Demographics
NPI:1023142270
Name:MARSTON, SANDRA IRENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:IRENE
Last Name:MARSTON
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 1:109 BLISS HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROYALSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01368-8914
Mailing Address - Country:US
Mailing Address - Phone:978-249-2637
Mailing Address - Fax:978-249-2637
Practice Address - Street 1:109 BLISS HILL RD
Practice Address - Street 2:
Practice Address - City:ROYALSTON
Practice Address - State:MA
Practice Address - Zip Code:01368-8914
Practice Address - Country:US
Practice Address - Phone:978-249-2637
Practice Address - Fax:978-249-2637
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN33813164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse