Provider Demographics
NPI:1205111473
Name:KENNEY, SANDRA LEE (LPN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:KENNEY
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 1:209 W CRISER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2360
Mailing Address - Country:US
Mailing Address - Phone:540-636-2931
Mailing Address - Fax:540-636-2933
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-2931
Practice Address - Fax:540-636-2933
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002015892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse