Provider Demographics
NPI:1205678307
Name:WILSON, SANDRA OWEN (RN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:OWEN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
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 761
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-0761
Mailing Address - Country:US
Mailing Address - Phone:346-901-1362
Mailing Address - Fax:
Practice Address - Street 1:10707 CORPORATE DR STE 250-120
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4095
Practice Address - Country:US
Practice Address - Phone:346-901-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691614163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice