Provider Demographics
NPI:1386409696
Name:OLDEMEYER, SANDRA KAYE (LPN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAYE
Last Name:OLDEMEYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 E FAKKEMA RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7846
Mailing Address - Country:US
Mailing Address - Phone:360-929-8678
Mailing Address - Fax:
Practice Address - Street 1:232 E FAKKEMA RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-7846
Practice Address - Country:US
Practice Address - Phone:360-929-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00039701164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse