1215131461 NPI number — MRS. SANDRA MARIE WISELEY M.A.

Table of content: MRS. SANDRA MARIE WISELEY M.A. (NPI 1215131461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215131461 NPI number — MRS. SANDRA MARIE WISELEY M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISELEY
Provider First Name:
SANDRA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KREIDLER
Provider Other First Name:
SANDRA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215131461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2192 STRINGTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE CITY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43123-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-875-5100
Provider Business Mailing Address Fax Number:
614-875-8529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2192 STRINGTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43123-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-875-5100
Provider Business Practice Location Address Fax Number:
614-875-8529
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A.01404 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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