Active NPI
Sandra Gail Koffman, CRNP
- Family Nurse Practitioner
- Bethesda, MD
National Provider Identifier
1538223136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 0024165954
- Practice address
- 10 Center Drive
BLDG 10/6C 306
Bethesda, MD 20892-1584 - Phone
- (301) 496-4411
- Fax
- (301) 637-0237
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0024165954 | VA | Primary |
Addresses
Primary practice location
10 Center Drive
BLDG 10/6C 306
Bethesda, MD 20892-1584
Mailing address
10 Center Drive
BLDG 10/6C 306
Bethesda, MD 20892-1584
Phone (301) 496-4411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010128455 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024165954 | VA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328572800000",
"number": "1538223136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CENTER DRIVE",
"address_2": "BLDG 10/6C 306",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208921584",
"telephone_number": "301-496-4411",
"fax_number": "301-637-0237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CENTER DRIVE",
"address_2": "BLDG 10/6C 306",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208921584",
"telephone_number": "301-496-4411",
"fax_number": "301-637-0237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOFFMAN",
"first_name": "SANDRA",
"middle_name": "GAIL",
"name_prefix": "Ms.",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2012-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "VA",
"license": "0024165954",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010128455",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.