Healthcare Provider Details

I. General information

NPI: 1194238485
Provider Name (Legal Business Name): GARTH RENTON LEADBETTER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 INVERNESS WAY S STE 125
CENTENNIAL CO
80112-5820
US

IV. Provider business mailing address

686 S HIGH ST
DENVER CO
80209-4527
US

V. Phone/Fax

Practice location:
  • Phone: 303-759-1342
  • Fax:
Mailing address:
  • Phone: 303-744-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.1622618
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: