MEDICARE: MRS. SANDRA SUE FERRIE R.N.

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	163WH0200X	Home Health Registered Nurse	RN 238948	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2300334	OTHER	OH	PROVIDER NUMBER

General Provider Information

NPI Number	:	1659591642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA SUE FERRIE R.N.

Provider Business Mailing Address
First Line	:	23937 ELM RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-3731
Country	:	US
Telephone Number	:	440-686-0128
Fax Number	:	440-686-0128

Provider Business Practice Location Address
First Line	:	25020 KENNEDY RIDGE RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-3465
Country	:	US
Telephone Number	:	440-777-1359
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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