Provider Demographics
NPI:1619782091
Name:CHURCHILL, SANDI JO (RN)
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:JO
Last Name:CHURCHILL
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 1:4711 PASO ROBLES CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-1647
Mailing Address - Country:US
Mailing Address - Phone:775-225-7691
Mailing Address - Fax:
Practice Address - Street 1:1117 48TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5442
Practice Address - Country:US
Practice Address - Phone:843-907-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC274832163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health