Healthcare Provider Details

I. General information

NPI: 1396249629
Provider Name (Legal Business Name): SANDY LEIGH HAMMON-RAUCHLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDY LEIGH RENFROW RN

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W MAPLE AVE
SPRINGDALE AR
72764
US

IV. Provider business mailing address

1671 FOXBORO CT
BENTONVILLE AR
72712-9369
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-5711
  • Fax:
Mailing address:
  • Phone: 417-861-2053
  • Fax: 479-751-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC003257
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: