Basic Information
| Provider Information | |||||||||
| NPI: | 1427047505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAMMANN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462372601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177821577 | ||||||||
| FaxNumber: | 3177805539 | ||||||||
| Practice Location | |||||||||
| Address1: | 5150 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462372601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177821577 | ||||||||
| FaxNumber: | 3177805539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 09/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 28076646 | IN | N | Nursing Service Providers | Registered Nurse | 363L00000X | 71000024 | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 71000024A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 3008212 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7100267480 | 05 | KY | MEDICAID | 100359300A | 05 | IN | MEDICAID | 50005027 | 01 | IN | RR MEDICARE | OTHER |