Healthcare Provider Details

I. General information

NPI: 1841293917
Provider Name (Legal Business Name): SANDRA K SULIER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 TRUST DR SUITE 114
HOLLAND OH
43528-9358
US

IV. Provider business mailing address

7127 MAPLEWOOD DR
TEMPERANCE MI
48182-1330
US

V. Phone/Fax

Practice location:
  • Phone: 419-887-8727
  • Fax: 419-491-0042
Mailing address:
  • Phone: 419-887-8727
  • Fax: 419-491-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN180761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: