Provider Demographics
NPI:1265203020
Name:REED-NELSON, SANDRA LYNN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:REED-NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 BETSY WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4940
Mailing Address - Country:US
Mailing Address - Phone:707-317-8196
Mailing Address - Fax:
Practice Address - Street 1:2618 BETSY WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4940
Practice Address - Country:US
Practice Address - Phone:707-317-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHBL-004005343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)