Provider Demographics
NPI:1942739859
Name:COULIBALY, SANDRA AMI (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:AMI
Last Name:COULIBALY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4534 VILLA PKWY UNIT A
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:651-434-7587
Mailing Address - Fax:651-340-7342
Practice Address - Street 1:4534 VILLA PKWY UNIT A
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1985
Practice Address - Country:US
Practice Address - Phone:651-434-7587
Practice Address - Fax:651-340-7342
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1086479-1HCBS364SH0200X
374J00000X
MNR180112-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No374J00000XNursing Service Related ProvidersDoula