Healthcare Provider Details

I. General information

NPI: 1639206618
Provider Name (Legal Business Name): BRENDA L LADTKOW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

11245 HURON ST
WESTMINSTER CO
80234-2806
US

V. Phone/Fax

Practice location:
  • Phone: 303-457-6606
  • Fax:
Mailing address:
  • Phone: 303-457-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number83921
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: