Healthcare Provider Details

I. General information

NPI: 1043908213
Provider Name (Legal Business Name): MOLLY MEGAN SIRKS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 21150
BOULDER CO
80308-4150
US

IV. Provider business mailing address

PO BOX 21150
BOULDER CO
80308-4150
US

V. Phone/Fax

Practice location:
  • Phone: 720-500-5488
  • Fax:
Mailing address:
  • Phone: 720-500-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12001476-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number12001476-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: