Provider Demographics
NPI:1396249348
Name:CRAIN, SANDRA ELAINE (NP-C)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ELAINE
Last Name:CRAIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:ELAINE
Other - Last Name:CRAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:12455 E 100TH ST N STE 350
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4675
Mailing Address - Country:US
Mailing Address - Phone:918-274-5510
Mailing Address - Fax:918-403-6312
Practice Address - Street 1:12455 E 100TH ST N STE 350
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4675
Practice Address - Country:US
Practice Address - Phone:918-274-5510
Practice Address - Fax:918-403-6312
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK67434363LG0600X, 363LP2300X
TXAP136171363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health