Healthcare Provider Details

I. General information

NPI: 1689283673
Provider Name (Legal Business Name): SARAH ANNE VIDAURRI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11684 HURON ST STE 104
NORTHGLENN CO
80234-2924
US

IV. Provider business mailing address

11684 HURON ST STE 104
NORTHGLENN CO
80234-2924
US

V. Phone/Fax

Practice location:
  • Phone: 720-588-3249
  • Fax:
Mailing address:
  • Phone: 720-588-3249
  • Fax: 833-468-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN.1617247
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995942-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: