Provider Demographics
NPI:1609014448
Name:SANDERS, NATHAN CODY (NBC-HIS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:CODY
Last Name:SANDERS
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 35TH AVE
Mailing Address - Street 2:UNIT A-103
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9475
Mailing Address - Country:US
Mailing Address - Phone:970-352-2132
Mailing Address - Fax:970-352-2133
Practice Address - Street 1:3109 35TH AVE
Practice Address - Street 2:UNIT A-103
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9475
Practice Address - Country:US
Practice Address - Phone:970-352-2132
Practice Address - Fax:970-352-2133
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist