Healthcare Provider Details

I. General information

NPI: 1922216266
Provider Name (Legal Business Name): BRUCE DENTON POULTER RN, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARAPAHOE AVE STE 10
BOULDER CO
80302-5815
US

IV. Provider business mailing address

611 DEWEY AVE
BOULDER CO
80304-3931
US

V. Phone/Fax

Practice location:
  • Phone: 720-312-7760
  • Fax:
Mailing address:
  • Phone: 720-312-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number85441
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: