Provider Demographics
NPI:1922210640
Name:YOUMATZ, SANDRA A (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:YOUMATZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:NORTH SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05150-9748
Mailing Address - Country:US
Mailing Address - Phone:317-850-8802
Mailing Address - Fax:
Practice Address - Street 1:137 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2544
Practice Address - Country:US
Practice Address - Phone:413-774-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2313846363LF0000X
IN71000403A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30348225Medicaid
VT1017792Medicaid
IN247020LMedicare PIN
NH30348225Medicaid