Provider Demographics
NPI:1679139539
Name:GANDY, SUANI (CPNP)
Entity Type:Individual
Prefix:
First Name:SUANI
Middle Name:
Last Name:GANDY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2610
Mailing Address - Country:US
Mailing Address - Phone:719-597-8704
Mailing Address - Fax:719-597-6864
Practice Address - Street 1:6071 E WOODMEN RD STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2610
Practice Address - Country:US
Practice Address - Phone:719-597-8704
Practice Address - Fax:719-597-6864
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1632938163W00000X
CO0994753-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse