Healthcare Provider Details

I. General information

NPI: 1790341196
Provider Name (Legal Business Name): SHAYLEE ALEXANDRIA ROWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 S REVERE PKWY STE 201
CENTENNIAL CO
80112-3931
US

IV. Provider business mailing address

6912 S QUENTIN ST STE 50
CENTENNIAL CO
80112-4531
US

V. Phone/Fax

Practice location:
  • Phone: 720-456-3989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number118681
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0004222-
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number118681
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: