Provider Demographics
NPI:1689908519
Name:HANSON, SARA LEIGH (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LEIGH
Last Name:HANSON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 CLEARVISTA PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4697
Mailing Address - Country:US
Mailing Address - Phone:317-621-7731
Mailing Address - Fax:317-621-7784
Practice Address - Street 1:8103 CLEARVISTA PKWY STE 260
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4697
Practice Address - Country:US
Practice Address - Phone:317-621-7731
Practice Address - Fax:317-621-7784
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000330A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology