Healthcare Provider Details

I. General information

NPI: 1548399058
Provider Name (Legal Business Name): SANDRA A REDHAGE RN-C, MSN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/14/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAKE SAINT LOUIS BLVD STE 136
LAKE ST LOUIS MO
63367-2911
US

IV. Provider business mailing address

926 LOCKSLEY MANOR DR
LAKE SAINT LOUIS MO
63367-2524
US

V. Phone/Fax

Practice location:
  • Phone: 636-735-3609
  • Fax:
Mailing address:
  • Phone: 314-265-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number120259
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: