Healthcare Provider Details

I. General information

NPI: 1164662052
Provider Name (Legal Business Name): SUNRISE HEALTH CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 PALMER PARK BLVD SUITE 101B
COLORADO SPRINGS CO
80909-3433
US

IV. Provider business mailing address

4020 PALMER PARK BLVD SUITE 101B
COLORADO SPRINGS CO
80909-3433
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-9977
  • Fax: 719-577-9911
Mailing address:
  • Phone: 719-577-9977
  • Fax: 719-577-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34753
License Number StateCO

VIII. Authorized Official

Name: DR. GRACE N NWEKE
Title or Position: PRESIDENT
Credential: MD
Phone: 719-577-9977