Provider Demographics
NPI:1912244195
Name:SADLER, CONNIE R (RN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:R
Last Name:SADLER
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 1:217 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4007
Mailing Address - Country:US
Mailing Address - Phone:662-322-9963
Mailing Address - Fax:
Practice Address - Street 1:217 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4007
Practice Address - Country:US
Practice Address - Phone:662-869-0061
Practice Address - Fax:662-842-7972
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR859944163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse