Provider Demographics
NPI:1093911984
Name:BLEVINS, SANDRA MARTIN (NP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARTIN
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 N PINEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8412
Mailing Address - Country:US
Mailing Address - Phone:303-841-5560
Mailing Address - Fax:
Practice Address - Street 1:7887 E BELLVIEW AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-6097
Practice Address - Country:US
Practice Address - Phone:303-770-0507
Practice Address - Fax:303-770-0501
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO446338Medicare ID - Type Unspecified