Healthcare Provider Details

I. General information

NPI: 1588636120
Provider Name (Legal Business Name): BRENDA LEE LARSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15132 E HAMPDEN AVE STE G
AURORA CO
80014-5038
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80113-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-6276
  • Fax:
Mailing address:
  • Phone: 303-360-6276
  • Fax: 303-761-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number105593
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: