Provider Demographics
NPI:1275313348
Name:SAGE, MICHAELE RENE' (RN)
Entity Type:Individual
Prefix:
First Name:MICHAELE
Middle Name:RENE'
Last Name:SAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1128 EAGLERIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2103
Mailing Address - Country:US
Mailing Address - Phone:193-202-4287
Mailing Address - Fax:
Practice Address - Street 1:1128 EAGLERIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2103
Practice Address - Country:US
Practice Address - Phone:719-778-1414
Practice Address - Fax:719-417-4999
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CORN.1658419163W00000X
COAPN.0999593-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse