Provider Demographics
NPI:1548399058
Name:REDHAGE, SANDRA A (RN-C, MSN, WHNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:REDHAGE
Suffix:
Gender:F
Credentials:RN-C, MSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7773
Mailing Address - Country:US
Mailing Address - Phone:314-993-7009
Mailing Address - Fax:314-993-1535
Practice Address - Street 1:10806 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7773
Practice Address - Country:US
Practice Address - Phone:314-993-7009
Practice Address - Fax:314-993-1535
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120259363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO120259OtherWOMEN'S HEALTH NP LICENSE