Provider Demographics
NPI:1699831313
Name:HOUSEHOLDER, SANDRA R (RN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:HOUSEHOLDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDUSTRY
Mailing Address - State:PA
Mailing Address - Zip Code:15052-1914
Mailing Address - Country:US
Mailing Address - Phone:724-495-3340
Mailing Address - Fax:
Practice Address - Street 1:918 3RD AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4613
Practice Address - Country:US
Practice Address - Phone:724-846-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN253118L163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice