Provider Demographics
NPI:1760838056
Name:HANLEY, SABRINA
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14308 STORMER RD
Mailing Address - Street 2:
Mailing Address - City:SALE CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37373-7726
Mailing Address - Country:US
Mailing Address - Phone:423-457-2440
Mailing Address - Fax:
Practice Address - Street 1:4589 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6076
Practice Address - Country:US
Practice Address - Phone:423-428-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85578164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN85578OtherLICENSE