Provider Demographics
NPI:1295235992
Name:STROUD, SALLY ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ELIZABETH
Last Name:STROUD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ELIZABETH
Other - Last Name:LAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6405 BACK BAY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1402
Mailing Address - Country:US
Mailing Address - Phone:512-698-7845
Mailing Address - Fax:
Practice Address - Street 1:6405 BACK BAY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1402
Practice Address - Country:US
Practice Address - Phone:512-698-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse