Provider Demographics
NPI:1265680615
Name:GIOVINAZZO-YATES, SANDRA L (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:GIOVINAZZO-YATES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5113
Mailing Address - Country:US
Mailing Address - Phone:651-642-2700
Mailing Address - Fax:651-642-9441
Practice Address - Street 1:2635 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1270
Practice Address - Country:US
Practice Address - Phone:651-603-7450
Practice Address - Fax:651-603-7385
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant