Provider Demographics
NPI:1740389493
Name:DENMAN, SANDRA N (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:N
Last Name:DENMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:36100 N BROOKSIDE DR STE 203
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4573
Practice Address - Country:US
Practice Address - Phone:847-855-1570
Practice Address - Fax:847-855-1890
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0385000369363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL597840Medicare PIN