Healthcare Provider Details

I. General information

NPI: 1821905050
Provider Name (Legal Business Name): BRETT PARKS SASINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 BEAVER BROOK CANYON RD
EVERGREEN CO
80439-4814
US

IV. Provider business mailing address

3440 BEAVER BROOK CANYON RD
EVERGREEN CO
80439-4814
US

V. Phone/Fax

Practice location:
  • Phone: 303-548-4250
  • Fax:
Mailing address:
  • Phone: 303-548-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1668469
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: