Basic Information
| Provider Information | |||||||||
| NPI: | 1588827786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAW | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | LEE. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 47 EATON AVE | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138151725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073162583 | ||||||||
| FaxNumber: | 6076744338 | ||||||||
| Practice Location | |||||||||
| Address1: | 47 EATON AVE | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138151725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073162583 | ||||||||
| FaxNumber: | 6076744338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 07/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 288624-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.