Provider Demographics
NPI:1427047505
Name:BAMMANN, SANDRA K (APRN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:K
Last Name:BAMMANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2601
Mailing Address - Country:US
Mailing Address - Phone:317-782-1577
Mailing Address - Fax:317-780-5539
Practice Address - Street 1:5150 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2601
Practice Address - Country:US
Practice Address - Phone:317-782-1577
Practice Address - Fax:317-780-5539
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28076646163W00000X
IN71000024363L00000X
IN71000024A363L00000X
KY3008212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100267480Medicaid
IN100359300AMedicaid
IN50005027OtherRR MEDICARE
IN50005027OtherRR MEDICARE
IN100359300AMedicaid
KYK100370Medicare PIN