Healthcare Provider Details

I. General information

NPI: 1447835608
Provider Name (Legal Business Name): REBEKA CHANDLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKA ROSE HUBER ACNP

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1624027
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0996726-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPN.0996726-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: