Provider Demographics
NPI:1043305022
Name:FORNEY, SANDRA L (CNM)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:FORNEY
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8064
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-7882
Mailing Address - Fax:314-454-5167
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:STE 341
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1402
Practice Address - Country:US
Practice Address - Phone:314-454-7882
Practice Address - Fax:314-454-5167
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-02-07
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Provider Licenses
StateLicense IDTaxonomies
MO082074367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife