MEDICARE: SANDRA LOUISE FLEMING STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	400357290504	OH

General Provider Information

NPI Number	:	1073912747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LOUISE FLEMING STNA

Provider Business Mailing Address
First Line	:	4067 E 142ND ST
Second Line	:	UP
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1859
Country	:	US
Telephone Number	:	216-410-9091
Fax Number	:

Provider Business Practice Location Address
First Line	:	4067 E 142ND ST
Second Line	:	UP
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1859
Country	:	US
Telephone Number	:	216-410-9091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/19/2014

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