Provider Demographics
NPI:1386841682
Name:ENGEBRETSEN, SANDRA LE GRANDE (ARNP)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LE GRANDE
Last Name:ENGEBRETSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:LE GRANDE
Other - Last Name:CHALMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1065 NE 125TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:1615 FOXTRAIL DR STE 230
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9087
Practice Address - Country:US
Practice Address - Phone:970-820-0470
Practice Address - Fax:877-720-0502
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 318832163WP0809X
CO0990322-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP62772Medicare ID - Type UnspecifiedUNIQUE PROVIDER ID