Provider Demographics
NPI:1366405557
Name:HEBENTHAL, SANDRA J (CRNA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:HEBENTHAL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:HILTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 FRIENDSHIP AVENUE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1722
Mailing Address - Country:US
Mailing Address - Phone:412-578-5323
Mailing Address - Fax:412-605-6424
Practice Address - Street 1:4800 FRIENDSHIP AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1722
Practice Address - Country:US
Practice Address - Phone:412-578-1354
Practice Address - Fax:412-578-4981
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN513313L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005502Medicaid
OH2638462Medicaid
OH2638462Medicaid