Provider Demographics
NPI:1386776805
Name:OEHRTMAN, SANDRA JEAN (CPNP, CNS, PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:OEHRTMAN
Suffix:
Gender:F
Credentials:CPNP, CNS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 N ERIE ST
Mailing Address - Street 2:BILLING RM 272
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5317
Mailing Address - Country:US
Mailing Address - Phone:419-213-4049
Mailing Address - Fax:419-213-4017
Practice Address - Street 1:635 N ERIE ST
Practice Address - Street 2:RM 272
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5317
Practice Address - Country:US
Practice Address - Phone:419-213-4049
Practice Address - Fax:419-213-4017
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-04935363LP0200X
OHNS-00181364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061022Medicaid