Provider Demographics
NPI:1427142181
Name:BERNARD, SANDRA LYNN (PA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:SCHOUTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5964 HERZMAN DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5407
Mailing Address - Country:US
Mailing Address - Phone:303-679-9251
Mailing Address - Fax:
Practice Address - Street 1:255 UNION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1859
Practice Address - Country:US
Practice Address - Phone:303-986-9583
Practice Address - Fax:303-986-2901
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2200OtherSTATE LICENSE