Provider Demographics
NPI:1750981486
Name:MURRAY, SANDRA JEAN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26946 CROCKER LNDG
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-9207
Mailing Address - Country:US
Mailing Address - Phone:575-937-2305
Mailing Address - Fax:
Practice Address - Street 1:26946 CROCKER LNDG
Practice Address - Street 2:
Practice Address - City:COLUMBIA STATION
Practice Address - State:OH
Practice Address - Zip Code:44028-9207
Practice Address - Country:US
Practice Address - Phone:575-937-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.441023163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant