Provider Demographics
NPI:1295561348
Name:AHUKANNA, SANDRA C
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:AHUKANNA
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 1:7910 HEADWATERS TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4457
Mailing Address - Country:US
Mailing Address - Phone:832-202-3227
Mailing Address - Fax:
Practice Address - Street 1:7910 HEADWATERS TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4457
Practice Address - Country:US
Practice Address - Phone:832-202-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX850791163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation