Individual
CHRISTINE M SANDRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6783 TERRY CHASE, OLIVE BRANCH, MS 38654-1448
(662) 209-9219
Mailing address
6783 TERRY CHASE, OLIVE BRANCH, MS 38654-1448
(662) 209-9219
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
269971
MS
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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Other
Enumeration date
03/04/2014
Last updated
02/01/2021
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