Provider Demographics
NPI:1689283673
Name:VIDAURRI, SARAH ANNE (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:VIDAURRI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11684 HURON ST
Mailing Address - Street 2:STE 104
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2924
Mailing Address - Country:US
Mailing Address - Phone:720-588-3249
Mailing Address - Fax:833-468-0039
Practice Address - Street 1:11684 HURON ST STE 104
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2924
Practice Address - Country:US
Practice Address - Phone:720-588-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1617247163WX0200X
COAPN.0995942-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology