Healthcare Provider Details

I. General information

NPI: 1386319929
Provider Name (Legal Business Name): SANDRA LEENELL HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA LEENELL BLACKWELL

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N GRAND ST
ENID OK
73701-3221
US

IV. Provider business mailing address

2214 N WASHINGTON ST
ENID OK
73701-2109
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-3791
  • Fax:
Mailing address:
  • Phone: 352-424-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: