MEDICARE: MS. CAMERON-K GARRETT RXN, CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	0048939	CO
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	0000381	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204330472	OTHER	CO	TAX ID

General Provider Information

NPI Number	:	1134274939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAMERON-K GARRETT RXN, CNS

Provider Business Mailing Address
First Line	:	7010 BROADWAY STE 210
Second Line	:	SUITE 210
City	:	DENVER
State	:	CO
Zip	:	80221-2921
Country	:	US
Telephone Number	:	303-650-1070
Fax Number	:	303-650-5970

Provider Business Practice Location Address
First Line	:	7010 BROADWAY STE 210
Second Line	:	SUITE 210
City	:	DENVER
State	:	CO
Zip	:	80221-2921
Country	:	US
Telephone Number	:	303-650-1070
Fax Number	:	303-650-5970

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/23/2013

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