Provider Demographics
NPI:1982960332
Name:ANNOR, SANDRA ROSE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ROSE
Last Name:ANNOR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N WOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9747
Mailing Address - Country:US
Mailing Address - Phone:937-829-6197
Mailing Address - Fax:
Practice Address - Street 1:50 E RIVERCENTER BLVD STE 434
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-1660
Practice Address - Country:US
Practice Address - Phone:833-358-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 343896163W00000X
OHAPRN.CNP.020263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse