Healthcare Provider Details

I. General information

NPI: 1033665419
Provider Name (Legal Business Name): JEANNEE L. SANDERS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 12/29/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17230 JACKSON CREEK PKWY STE 260
MONUMENT CO
80132-7305
US

IV. Provider business mailing address

17230 JACKSON CREEK PKWY STE 260
MONUMENT CO
80132-7305
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-4740
  • Fax: 719-776-4750
Mailing address:
  • Phone: 719-776-4740
  • Fax: 719-776-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.09927-13NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.09927-13NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number0125865
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: