Healthcare Provider Details

I. General information

NPI: 1578826863
Provider Name (Legal Business Name): SANDRA D EWER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-3733
US

IV. Provider business mailing address

1420 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-3735
US

V. Phone/Fax

Practice location:
  • Phone: 719-255-4444
  • Fax: 719-255-4446
Mailing address:
  • Phone: 719-255-4444
  • Fax: 719-255-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP121045
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCNP121045
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0996125-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: