Healthcare Provider Details

I. General information

NPI: 1235262981
Provider Name (Legal Business Name): LAURIE SANDBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD SUITE 108
HAGERSTOWN MD
21742-6700
US

IV. Provider business mailing address

11116 MEDICAL CAMPUS RD STE 2950
HAGERSTOWN MD
21742-6710
US

V. Phone/Fax

Practice location:
  • Phone: 301-714-4041
  • Fax: 301-714-4351
Mailing address:
  • Phone: 301-790-8907
  • Fax: 301-417-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR072839
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR072839
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: