Provider Demographics
NPI:1750724563
Name:PRICE, SANDRA ELAINE
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELAINE
Last Name:PRICE
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 1:3217 BLUEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-4831
Mailing Address - Country:US
Mailing Address - Phone:901-331-4414
Mailing Address - Fax:901-353-2315
Practice Address - Street 1:3217 BLUEFIELD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-4831
Practice Address - Country:US
Practice Address - Phone:901-331-4414
Practice Address - Fax:901-353-2315
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide