Provider Demographics
NPI:1841293917
Name:SULIER, SANDRA K (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:SULIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7127 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1330
Mailing Address - Country:US
Mailing Address - Phone:419-887-8727
Mailing Address - Fax:419-491-0042
Practice Address - Street 1:6135 TRUST DR
Practice Address - Street 2:SUITE 114
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9358
Practice Address - Country:US
Practice Address - Phone:419-887-8727
Practice Address - Fax:419-491-0042
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN180761363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2239385Medicaid
OHNP06782Medicare PIN
OH2239385Medicaid