Provider Demographics
NPI:1992034458
Name:OETTING, SANDRA K (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:K
Last Name:OETTING
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30000 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3429
Mailing Address - Country:US
Mailing Address - Phone:419-931-3440
Mailing Address - Fax:419-661-4020
Practice Address - Street 1:718 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-7815
Practice Address - Country:US
Practice Address - Phone:734-240-8400
Practice Address - Fax:419-824-7359
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 17191 NP363L00000X
MI4704185806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992034458Medicaid
MI0129568Medicaid
OHH429260OtherMEDICARE PIN
MIMI4068021OtherMEDICARE
OH0129568Medicaid