Provider Demographics
NPI:1659113728
Name:SANDS, COREY ANSON
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ANSON
Last Name:SANDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74101-1101
Mailing Address - Country:US
Mailing Address - Phone:918-245-0231
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74101-1101
Practice Address - Country:US
Practice Address - Phone:918-245-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator