Provider Demographics
NPI:1447247358
Name:YANEY, SANDRA FOLSOM (APRN-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:FOLSOM
Last Name:YANEY
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:FOLSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2906 BEACON STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-651-3198
Mailing Address - Fax:719-473-5798
Practice Address - Street 1:2906 BEACON STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-651-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0000549-NP363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC77336Medicare PIN
S88769Medicare UPIN
S88769Medicare UPIN