Healthcare Provider Details

I. General information

NPI: 1962286757
Provider Name (Legal Business Name): JACQUELINE DUBUQUE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S POTOMAC ST
AURORA CO
80012-5411
US

IV. Provider business mailing address

920 S PARIS CT
AURORA CO
80012-3281
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-2600
  • Fax:
Mailing address:
  • Phone: 631-831-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRTL.0006314
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: