MEDICARE: SANDRA JO HOULIHAN

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	163W00000X	Registered Nurse	113495	MO

General Provider Information

NPI Number	:	1659265858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA JO HOULIHAN

Provider Business Mailing Address
First Line	:	18991 LAWRENCE 1020
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-7416
Country	:	US
Telephone Number	:	417-772-4077
Fax Number	:

Provider Business Practice Location Address
First Line	:	18991 LAWRENCE 1020
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-7416
Country	:	US
Telephone Number	:	417-772-4077
Fax Number	:

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

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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Directions to “ SANDRA JO HOULIHAN ” Practice Location

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