Provider Demographics
NPI:1396295044
Name:LANDRY, SANDRA (APRN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:HYAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:1617 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4709
Practice Address - Country:US
Practice Address - Phone:817-702-3100
Practice Address - Fax:817-702-4847
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX839596163WP0200X
MN239164-9163W00000X
MN4796363L00000X
MNCNP 4796363LP0808X
TX1006644363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner