Healthcare Provider Details

I. General information

NPI: 1053233551
Provider Name (Legal Business Name): ALICIA CRONQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6964 S LIMA ST
CENTENNIAL CO
80112-3881
US

IV. Provider business mailing address

6964 S LIMA ST
CENTENNIAL CO
80112-3881
US

V. Phone/Fax

Practice location:
  • Phone: 303-795-4584
  • Fax:
Mailing address:
  • Phone: 303-795-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0162814
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: