Provider Demographics
NPI:1114521218
Name:SANDS, EMILY ANNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:SANDS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:SPRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6119 STELLHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5357
Mailing Address - Country:US
Mailing Address - Phone:260-485-4697
Mailing Address - Fax:260-247-7172
Practice Address - Street 1:101 E PARK DR
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IN
Practice Address - Zip Code:46701-1438
Practice Address - Country:US
Practice Address - Phone:574-385-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029007A183500000X
IN28277462A163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No183500000XPharmacy Service ProvidersPharmacist