Healthcare Provider Details

I. General information

NPI: 1285179176
Provider Name (Legal Business Name): HALEIGH NICOLE BORNEMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 S SABLE BLVD
AURORA CO
80012-3796
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80113-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-552-9577
  • Fax:
Mailing address:
  • Phone: 303-360-6276
  • Fax: 303-343-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992823-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1644652
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: