Healthcare Provider Details

I. General information

NPI: 1164549721
Provider Name (Legal Business Name): SANDRA R. COULSON B.A., COM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S ONEIDA ST SUITE 335
DENVER CO
80224-2549
US

IV. Provider business mailing address

2121 S ONEIDA ST SUITE 335
DENVER CO
80224-2549
US

V. Phone/Fax

Practice location:
  • Phone: 303-759-2760
  • Fax: 303-759-2971
Mailing address:
  • Phone: 303-759-2760
  • Fax: 303-759-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number71-C-8
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: