Healthcare Provider Details

I. General information

NPI: 1386841682
Provider Name (Legal Business Name): SANDRA LE GRANDE ENGEBRETSEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA LE GRANDE CHALMERS ARNP

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 FOXTRAIL DR STE 230
LOVELAND CO
80538-9087
US

IV. Provider business mailing address

1065 NE 125TH ST STE 409
NORTH MIAMI FL
33161-5834
US

V. Phone/Fax

Practice location:
  • Phone: 970-820-0470
  • Fax: 877-720-0502
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0990322-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberARNP 318832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: