Provider Demographics
NPI:1548399058
Name:REDHAGE, SANDRA A (RN-C, MSN, WHNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:REDHAGE
Suffix:
Gender:F
Credentials:RN-C, MSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 LOCKSLEY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2524
Mailing Address - Country:US
Mailing Address - Phone:314-265-5993
Mailing Address - Fax:
Practice Address - Street 1:1000 LAKE SAINT LOUIS BLVD STE 136
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2911
Practice Address - Country:US
Practice Address - Phone:636-735-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120259363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO120259OtherWOMEN'S HEALTH NP LICENSE