Provider Demographics
NPI:1144342106
Name:NEBL, SANDRA KAY (RN, MSN, ACNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:NEBL
Suffix:
Gender:F
Credentials:RN, MSN, ACNP
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Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-542-0809
Practice Address - Street 1:1600 N. GRAND AVE.
Practice Address - Street 2:STE 260
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2729
Practice Address - Country:US
Practice Address - Phone:719-562-2010
Practice Address - Fax:719-562-2097
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO84013363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07840135Medicaid
CO303867YK2DMedicare PIN