Provider Demographics
NPI:1609347848
Name:YAMANE, SANDRA STROUD (AGNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:STROUD
Last Name:YAMANE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3202
Mailing Address - Country:US
Mailing Address - Phone:336-402-2597
Mailing Address - Fax:
Practice Address - Street 1:675 E LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2625
Practice Address - Country:US
Practice Address - Phone:336-751-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010204363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care