Sandra Dean Mumford, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

86009 Issued in IN

Practice address

2600 Greenbush St
Lafayette, IN 47904-2477

Phone

(765) 448-8000

Fax

(765) 838-5150

NPI assigned

Jan 28, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  • Boise, ID
  • NPI 1255401436
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1114223872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W BELVEDERE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155216",
            "telephone_number": "410-601-5209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 GREENBUSH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042477",
            "telephone_number": "765-448-8000",
            "fax_number": "765-838-5150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 W Belvedere Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212155216",
            "country_code": "US",
            "telephone_number": "410-601-5209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUMFORD",
        "first_name": "SANDRA",
        "middle_name": "DEAN",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28240085A",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "N-20588",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "86009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "PENDING",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300008420",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Anne Mulhaupt-Wolf, RN BSN
• Samantha Mull
• Madison Mullen
• Amanda Brooke Mulligan, SLP
• Erika Marie Mullins, NP
• Erin Renee Munday, SLP
• Murley Optometric Inc., P.C.
• Erin Beth Murley, O.D.
• Grace Elizabeth Muroski
• Alison Murphy, OTR

• Certified Registered Nurse Anesthetist in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Certified Registered Nurse Anesthetist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.