Healthcare Provider Details

I. General information

NPI: 1740896893
Provider Name (Legal Business Name): COLLEEN ELLEN BALLARD RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S PARKER RD # S400
AURORA CO
80014-1622
US

IV. Provider business mailing address

14241 MOSAIC DR
PARKER CO
80134-4059
US

V. Phone/Fax

Practice location:
  • Phone: 720-863-7333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN.1670009
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: