Healthcare Provider Details

I. General information

NPI: 1962082933
Provider Name (Legal Business Name): BAILEY ROSE BUHR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N URSULA ST UNIT 425
AURORA CO
80045-7412
US

IV. Provider business mailing address

2100 N URSULA ST UNIT 425
AURORA CO
80045-7412
US

V. Phone/Fax

Practice location:
  • Phone: 171-993-7148
  • Fax:
Mailing address:
  • Phone: 171-993-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0007416
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: