Healthcare Provider Details

I. General information

NPI: 1972950020
Provider Name (Legal Business Name): SYREETA SPEARS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE GARY PAVILION 4TH FLOOR
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE GARY PAVILION 4TH FLOOR
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-3502
  • Fax: 720-777-7311
Mailing address:
  • Phone: 720-777-3502
  • Fax: 720-777-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0181932
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0993017-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: