Healthcare Provider Details

I. General information

NPI: 1649246489
Provider Name (Legal Business Name): SANDRA SUE WARD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

PO BOX 640446
CINCINNATI OH
45264-0446
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8228
  • Fax:
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN168704
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.00471
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: