MEDICARE: SANDRA K SULIER NP

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	363LW0102X	Women's Health Nurse Practitioner	RN180761	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841293917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA K SULIER NP

Provider Business Mailing Address
First Line	:	7127 MAPLEWOOD DR
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1330
Country	:	US
Telephone Number	:	419-887-8727
Fax Number	:	419-491-0042

Provider Business Practice Location Address
First Line	:	6135 TRUST DR
Second Line	:	SUITE 114
City	:	HOLLAND
State	:	OH
Zip	:	43528-9358
Country	:	US
Telephone Number	:	419-887-8727
Fax Number	:	419-491-0042

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/14/2012

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