MEDICARE: MR. BRUCE DENTON POULTER RN, MPH

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	85441	CO

General Provider Information

NPI Number	:	1922216266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE DENTON POULTER RN, MPH

Provider Business Mailing Address
First Line	:	611 DEWEY AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3931
Country	:	US
Telephone Number	:	720-312-7760
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ARAPAHOE AVE STE 10
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5815
Country	:	US
Telephone Number	:	720-312-7760
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/25/2025

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