Provider Demographics
NPI:1932437167
Name:STOM, SANDRA ANN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANN
Last Name:STOM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8095
Mailing Address - Country:US
Mailing Address - Phone:860-788-6404
Mailing Address - Fax:860-398-6441
Practice Address - Street 1:600 N 2ND ST STE 401
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1071
Practice Address - Country:US
Practice Address - Phone:860-788-6404
Practice Address - Fax:860-398-6441
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily