Healthcare Provider Details

I. General information

NPI: 1922983493
Provider Name (Legal Business Name): SARA ANDRYSHAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5921 ICEBERG PASS WAY
COLORADO SPRINGS CO
80923-3468
US

IV. Provider business mailing address

5921 ICEBERG PASS WAY
COLORADO SPRINGS CO
80923-3468
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-0972
  • Fax:
Mailing address:
  • Phone: 719-373-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number200127
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: