Healthcare Provider Details

I. General information

NPI: 1831550151
Provider Name (Legal Business Name): CLIFTON WILLMENG R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 S PARKER RD
AURORA CO
80014-1623
US

IV. Provider business mailing address

1246 DORIC DR
LAFAYETTE CO
80026-1201
US

V. Phone/Fax

Practice location:
  • Phone: 303-306-2699
  • Fax:
Mailing address:
  • Phone: 303-478-6613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0190681
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: