Provider Demographics
NPI:1538223136
Name:KOFFMAN, SANDRA GAIL (CRNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:GAIL
Last Name:KOFFMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE
Mailing Address - Street 2:BLDG 10/6C 306
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1584
Mailing Address - Country:US
Mailing Address - Phone:301-496-4411
Mailing Address - Fax:301-637-0237
Practice Address - Street 1:10 CENTER DRIVE
Practice Address - Street 2:BLDG 10/6C 306
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1584
Practice Address - Country:US
Practice Address - Phone:301-496-4411
Practice Address - Fax:301-637-0237
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010128455Medicaid
VAS5952Medicare UPIN
VA010128455Medicaid