Healthcare Provider Details

I. General information

NPI: 1194841163
Provider Name (Legal Business Name): DENNIS W RICHARDS ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WARDENBURG HEALTH CTR BOX 119
BOULDER CO
80309-0119
US

IV. Provider business mailing address

504 HAPGOOD ST
BOULDER CO
80302-6966
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-5101
  • Fax:
Mailing address:
  • Phone: 303-449-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number66969
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: