Healthcare Provider Details

I. General information

NPI: 1033965827
Provider Name (Legal Business Name): SANDRA MARY MELLING APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 W COLFAX AVE STE B300
LAKEWOOD CO
80215-3753
US

IV. Provider business mailing address

12600 W COLFAX AVE STE B300
LAKEWOOD CO
80215-3753
US

V. Phone/Fax

Practice location:
  • Phone: 303-993-1330
  • Fax: 303-647-3647
Mailing address:
  • Phone: 303-993-1330
  • Fax: 303-647-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0998858-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: