Provider Demographics
NPI:1194587667
Name:STORMS, ZANDRA (STNA)
Entity type:Individual
Prefix:
First Name:ZANDRA
Middle Name:
Last Name:STORMS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:MOWRYSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45155-0046
Mailing Address - Country:US
Mailing Address - Phone:937-661-5151
Mailing Address - Fax:
Practice Address - Street 1:14 SOUTH HIGH ST
Practice Address - Street 2:
Practice Address - City:MOWRYSTOWN
Practice Address - State:OH
Practice Address - Zip Code:45155
Practice Address - Country:US
Practice Address - Phone:937-205-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602633460623376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide