Provider Demographics
NPI:1992044515
Name:GWINN, SANDRA L (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:GWINN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6162 S. WILLOW DRIVE
Mailing Address - Street 2:#100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-220-9200
Mailing Address - Fax:303-741-4173
Practice Address - Street 1:6162 S. WILLOW DRIVE
Practice Address - Street 2:#100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-220-9200
Practice Address - Fax:303-741-4173
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1617698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse