Provider Demographics
NPI:1497823652
Name:SANDERS, RALPH BRENT (RN MSN CNS RXN)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:BRENT
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RN MSN CNS RXN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MADISON ST STE 302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5412
Mailing Address - Country:US
Mailing Address - Phone:720-331-6899
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST STE 302
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5412
Practice Address - Country:US
Practice Address - Phone:720-331-6899
Practice Address - Fax:720-306-5499
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80032CNS364SP0809X
COAPN.0002986-CNS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01875752Medicaid