Healthcare Provider Details

I. General information

NPI: 1992044515
Provider Name (Legal Business Name): SANDRA L GWINN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6162 S. WILLOW DRIVE #100
GREENWOOD VILLAGE CO
80111
US

IV. Provider business mailing address

6162 S. WILLOW DRIVE #100
GREENWOOD VILLAGE CO
80111
US

V. Phone/Fax

Practice location:
  • Phone: 303-220-9200
  • Fax: 303-741-4173
Mailing address:
  • Phone: 303-220-9200
  • Fax: 303-741-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1617698
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: