Provider Demographics
NPI:1124313119
Name:CARROLL, SANDRA LEA (DVM)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 S 82ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4425
Mailing Address - Country:US
Mailing Address - Phone:414-476-3544
Mailing Address - Fax:414-476-3529
Practice Address - Street 1:1736 S 82ND ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4425
Practice Address - Country:US
Practice Address - Phone:414-476-3544
Practice Address - Fax:414-476-3529
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5462-050174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian