Healthcare Provider Details

I. General information

NPI: 1083746275
Provider Name (Legal Business Name): CARLA MAY OGDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 13TH ST
BOULDER CO
80304-3518
US

IV. Provider business mailing address

2818 13TH ST
BOULDER CO
80304-3518
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-5140
  • Fax: 303-440-5144
Mailing address:
  • Phone: 303-440-5140
  • Fax: 303-440-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number57320
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: