Provider Demographics
NPI:1396249629
Name:HAMMON-RAUCHLE, SANDY LEIGH (RN)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:LEIGH
Last Name:HAMMON-RAUCHLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:LEIGH
Other - Last Name:RENFROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1671 FOXBORO CT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9369
Mailing Address - Country:US
Mailing Address - Phone:417-861-2053
Mailing Address - Fax:479-751-1099
Practice Address - Street 1:609 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764
Practice Address - Country:US
Practice Address - Phone:479-751-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC003257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered