Healthcare Provider Details

I. General information

NPI: 1497826200
Provider Name (Legal Business Name): SANDRA J. HANLIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 ANGIES WAY SUITE 230
LOUISVILLE KY
40241-2851
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-4263
  • Fax: 502-629-4282
Mailing address:
  • Phone: 502-969-6552
  • Fax: 502-969-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005025
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1057235
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: