Healthcare Provider Details

I. General information

NPI: 1407568785
Provider Name (Legal Business Name): CORBIN DRAKE SANCHEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 CREE DR
COLORADO SPRINGS CO
80915-3261
US

IV. Provider business mailing address

1144 CREE DR
COLORADO SPRINGS CO
80915-3261
US

V. Phone/Fax

Practice location:
  • Phone: 719-469-1703
  • Fax:
Mailing address:
  • Phone: 719-469-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number1661901
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number1661901
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number1661901
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1661901
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1661901
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: