Provider Demographics
NPI:1629088174
Name:HAYDEN, SANDRA L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 66971-CC
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166
Mailing Address - Country:US
Mailing Address - Phone:866-633-0610
Mailing Address - Fax:314-548-4747
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006080367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered