Healthcare Provider Details

I. General information

NPI: 1588305890
Provider Name (Legal Business Name): JULIA GRACE NYIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 07/03/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE
AURORA CO
80045-2527
US

IV. Provider business mailing address

1240 S FLOWER CIR APT C
LAKEWOOD CO
80232-2022
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-6601
  • Fax:
Mailing address:
  • Phone: 303-514-5943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: