Provider Demographics
NPI:1306005426
Name:SANDERS, COLLEEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 SHADY GROVE RD
Mailing Address - Street 2:140
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4008
Mailing Address - Country:US
Mailing Address - Phone:301-869-9776
Mailing Address - Fax:
Practice Address - Street 1:2639 CONNECTICUT AVE NW
Practice Address - Street 2:C-100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1537
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC11013Medicare UPIN