MEDICARE: RALPH BRENT SANDERS RN MSN CNS RXN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	80032CNS	CO
2	364S00000X	Clinical Nurse Specialist	APN.0002986-CNS	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497823652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH BRENT SANDERS RN MSN CNS RXN

Provider Business Mailing Address
First Line	:	90 MADISON ST STE 302
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5412
Country	:	US
Telephone Number	:	720-331-6899
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 MADISON ST STE 302
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5412
Country	:	US
Telephone Number	:	720-331-6899
Fax Number	:	720-306-5499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	06/24/2022

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