Healthcare Provider Details

I. General information

NPI: 1871314633
Provider Name (Legal Business Name): MRS. TRINA MARIE DELEON-GAGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40851 E COUNTY ROAD 6
BENNETT CO
80102-8787
US

IV. Provider business mailing address

40851 E COUNTY ROAD 6
BENNETT CO
80102-8787
US

V. Phone/Fax

Practice location:
  • Phone: 720-810-4628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10000240
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: