Healthcare Provider Details

I. General information

NPI: 1265043822
Provider Name (Legal Business Name): MICHELLE LEE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LEE KUGLER RN

II. Dates (important events)

Enumeration Date: 08/16/2020
Last Update Date: 08/16/2020
Certification Date: 08/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 POTOMAC ST STE 111
AURORA CO
80011-6743
US

IV. Provider business mailing address

5488 UINTA ST
DENVER CO
80238-3824
US

V. Phone/Fax

Practice location:
  • Phone: 303-343-3121
  • Fax:
Mailing address:
  • Phone: 720-454-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995541-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: