Healthcare Provider Details

I. General information

NPI: 1720119548
Provider Name (Legal Business Name): BRENDA LEE NELSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA LEE BAKER PA

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE J
CASTLE PINES CO
80108-9454
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 301
HIGHLANDS RANCH CO
80129-2277
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax: 303-814-6491
Mailing address:
  • Phone: 303-814-0505
  • Fax: 303-814-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0000675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: