Healthcare Provider Details

I. General information

NPI: 1568878023
Provider Name (Legal Business Name): MIRIAM HALAZON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2014
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S POTOMAC ST STE 300
AURORA CO
80012-4510
US

IV. Provider business mailing address

1444 S POTOMAC ST STE 300
AURORA CO
80012-4510
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-0822
  • Fax: 303-750-1298
Mailing address:
  • Phone: 303-750-0822
  • Fax: 303-750-1298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991249-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: