Provider Demographics
NPI:1881711398
Name:MAHONEY, SANDRA LEE ANN (ANP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE ANN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 UNIVERSITY LAKE DRIVE, STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4644
Mailing Address - Country:US
Mailing Address - Phone:907-222-9930
Mailing Address - Fax:907-222-9931
Practice Address - Street 1:3976 UNIVERSITY LAKE DR STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4644
Practice Address - Country:US
Practice Address - Phone:907-222-9930
Practice Address - Fax:907-222-9931
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK942363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1581140Medicaid
AK164766Medicare PIN
AKMDG798OtherMEDICAID GROUP
AK164766Medicare PIN