Provider Demographics
NPI:1962443853
Name:ANDREW, SANDRA (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ANDREW
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 1:2222 N NEVADA AVE
Mailing Address - Street 2:# 4001
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6831
Mailing Address - Country:US
Mailing Address - Phone:719-636-9393
Mailing Address - Fax:719-636-9087
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:# 4001
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6831
Practice Address - Country:US
Practice Address - Phone:719-636-9393
Practice Address - Fax:719-636-9087
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42025320Medicaid
S96144Medicare UPIN
484848Medicare ID - Type Unspecified