Provider Demographics
NPI:1265600704
Name:JEPPESEN, SANDRA C (APRN, CRNA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:JEPPESEN
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:C
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, CRNA
Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:ST 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:326 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2740
Practice Address - Country:US
Practice Address - Phone:860-889-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000575367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004199643Medicaid
CT430033147OtherRAILROAD MEDICARE
CT430033147OtherRAILROAD MEDICARE
CT430000116Medicare PIN