MEDICARE: MRS. YOLANDA JEAN BRUNSMA SANDOVAL SW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	M05654	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306998505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YOLANDA JEAN BRUNSMA SANDOVAL SW

Provider Business Mailing Address
First Line	:	4725 CANDELARIA RD NE
Second Line	:	BEL AIR ES
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1818
Country	:	US
Telephone Number	:	505-888-4511
Fax Number	:

Provider Business Practice Location Address
First Line	:	4725 CANDELARIA RD NE
Second Line	:	BEL AIR ES
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1818
Country	:	US
Telephone Number	:	505-888-4511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/28/2007

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