Provider Demographics
NPI:1720086630
Name:NUZUM, SANDRA M (CNM)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:M
Last Name:NUZUM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-872-3201
Mailing Address - Fax:419-872-3208
Practice Address - Street 1:2751 BAY PARK DR.
Practice Address - Street 2:SUITE #300
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616
Practice Address - Country:US
Practice Address - Phone:419-690-7596
Practice Address - Fax:419-697-6707
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNM07498367A00000X
OHNM-07498367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05225OtherPARAMOUNT
OH344428256OtherFRONTPATH
OH344428256OtherBEECH STREET
OH000000320549OtherANTHEM
OH344428256OtherHEALTHNET
OH2454044Medicaid
OH344428256088OtherCARESOURCE
OH344428256OtherBEECHSTREET
MI4584759Medicaid
MI4584768Medicaid
MI4584759Medicaid
OH344428256OtherBEECH STREET