MEDICARE: SANDRA K MCKEE RN

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	163W00000X	Registered Nurse	089410	MO

General Provider Information

NPI Number	:	1487897526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA K MCKEE RN

Provider Business Mailing Address
First Line	:	2955 GRAN LIN DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-6042
Country	:	US
Telephone Number	:	636-922-2962
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 GRAN LIN DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-6042
Country	:	US
Telephone Number	:	636-922-2962
Fax Number	:

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

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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