Healthcare Provider Details

I. General information

NPI: 1194064634
Provider Name (Legal Business Name): SANDRA MCGUIRE NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CENTRAL AVENUE
DOLORES CO
81323
US

IV. Provider business mailing address

11621 COUNTY ROAD 38.5
MANCOS CO
81328
US

V. Phone/Fax

Practice location:
  • Phone: 970-882-7221
  • Fax:
Mailing address:
  • Phone: 970-533-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberNP990365
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: