Provider Demographics
NPI:1538623558
Name:FRUITHANDLER, SARA (APN)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:FRUITHANDLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 W OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3106
Mailing Address - Country:US
Mailing Address - Phone:303-315-6150
Mailing Address - Fax:720-259-4559
Practice Address - Street 1:3525 W OXFORD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3106
Practice Address - Country:US
Practice Address - Phone:303-315-6150
Practice Address - Fax:720-259-4559
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN1636769163W00000X
COAPN.0997647-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1538623558Medicaid