Provider Demographics
NPI:1285879452
Name:GARDNER, SARAH JANE (RPA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:MONROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-4101
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:4743 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1123
Practice Address - Country:US
Practice Address - Phone:303-443-2123
Practice Address - Fax:303-443-9497
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002730363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO305082Medicare PIN
CO480288YLL6Medicare PIN