Healthcare Provider Details

I. General information

NPI: 1457420945
Provider Name (Legal Business Name): HANNAH P SANDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 SAND CANYON RD
YUCAIPA CA
92399-1742
US

IV. Provider business mailing address

11711 SAND CANYON RD
YUCAIPA CA
92399-1742
US

V. Phone/Fax

Practice location:
  • Phone: 909-389-3272
  • Fax:
Mailing address:
  • Phone: 909-389-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number160601
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 17642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: