Provider Demographics
NPI:1134558364
Name:BROWN, SANDRA J (CNA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1813
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-7813
Mailing Address - Country:US
Mailing Address - Phone:801-318-5676
Mailing Address - Fax:801-798-7720
Practice Address - Street 1:1190 E 1000 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2913
Practice Address - Country:US
Practice Address - Phone:801-798-7720
Practice Address - Fax:801-798-7720
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT000205100809376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide