Provider Demographics
NPI:1497826200
Name:HANLIN, SANDRA J (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:HANLIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 230
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-629-4263
Practice Address - Fax:502-629-4282
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1057235163W00000X
KY3005025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY105938OtherSIHO
KY000000626840 NHCOtherANTHEM
KY4040339OtherCIGNA
IN200965990Medicaid
KY50025712OtherPASSPORT
KY3736658000OtherPASSPORT ADVANTAGE
KY50025712OtherPASSPORT