Provider Demographics
NPI:1467756866
Name:LAHENS, SANDRALE M
Entity Type:Individual
Prefix:
First Name:SANDRALE
Middle Name:M
Last Name:LAHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23020 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3641
Mailing Address - Country:US
Mailing Address - Phone:347-822-8049
Mailing Address - Fax:
Practice Address - Street 1:23020 LANSING AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3641
Practice Address - Country:US
Practice Address - Phone:347-822-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301864164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse