Basic Information
| Provider Information | |||||||||
| NPI: | 1497826200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANLIN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029696552 | ||||||||
| FaxNumber: | 5029693799 | ||||||||
| Practice Location | |||||||||
| Address1: | 9880 ANGIES WAY | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026294263 | ||||||||
| FaxNumber: | 5026294282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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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 | 1057235 | KY | N | Nursing Service Providers | Registered Nurse | 363L00000X | 3005025 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 105938 | 01 | KY | SIHO | OTHER | 000000626840 NHC | 01 | KY | ANTHEM | OTHER | 4040339 | 01 | KY | CIGNA | OTHER | 200965990 | 05 | IN | MEDICAID | 50025712 | 01 | KY | PASSPORT | OTHER | 3736658000 | 01 | KY | PASSPORT ADVANTAGE | OTHER |