Provider Demographics
NPI:1285966028
Name:PEREBZAK, SANDRA L (RN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:PEREBZAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:KNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:148 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:QUAKER CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43773-9619
Mailing Address - Country:US
Mailing Address - Phone:740-679-3257
Mailing Address - Fax:
Practice Address - Street 1:43 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9004
Practice Address - Country:US
Practice Address - Phone:740-732-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.320033163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse