Provider Demographics
NPI:1942540414
Name:KAPSO, SANDRA LANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LANE
Last Name:KAPSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 WATER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1430
Mailing Address - Country:US
Mailing Address - Phone:812-256-3381
Mailing Address - Fax:812-256-7346
Practice Address - Street 1:935 WATER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-1430
Practice Address - Country:US
Practice Address - Phone:812-256-3381
Practice Address - Fax:812-256-7346
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004309A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner