Provider Demographics
NPI:1982648002
Name:SANDINE, JULIE ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SANDINE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:NEW WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1031
Mailing Address - Country:US
Mailing Address - Phone:317-535-5661
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2920
Practice Address - Fax:317-988-2171
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28084354163W00000X
IN71001044A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INVAD000Medicare UPIN