Provider Demographics
NPI:1396896221
Name:HARPER, SANDRA (RN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:HARPER
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 1:6330 W LISBON AVE
Mailing Address - Street 2:APT. 5
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2141
Mailing Address - Country:US
Mailing Address - Phone:414-873-8556
Mailing Address - Fax:
Practice Address - Street 1:6330 W LISBON AVE
Practice Address - Street 2:APT. 5
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2141
Practice Address - Country:US
Practice Address - Phone:414-873-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse