Healthcare Provider Details

I. General information

NPI: 1336125103
Provider Name (Legal Business Name): JULIE ANSELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 48TH ST STE 200
BOULDER CO
80301-2712
US

IV. Provider business mailing address

203 S ROLLIE AVE BILLING DEPT/CREDENTIALIST
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-7450
  • Fax: 303-494-5265
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0042406
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: