Healthcare Provider Details

I. General information

NPI: 1750969002
Provider Name (Legal Business Name): SANDRA LEE RANNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 COCHRANE CIR BLDG 7494
FORT CARSON CO
80913-4603
US

IV. Provider business mailing address

6755 BLUE RIVER WAY
COLORADO SPRINGS CO
80911-9679
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-0393
  • Fax:
Mailing address:
  • Phone: 719-205-2553
  • Fax: 719-526-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0109484
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: