Healthcare Provider Details

I. General information

NPI: 1912371964
Provider Name (Legal Business Name): ASHLEY DIANNE DEGRUSH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 S HAVANA ST STE 100-81
CENTENNIAL CO
80112-3891
US

IV. Provider business mailing address

7173 S HAVANA ST STE 100-81
CENTENNIAL CO
80112-3891
US

V. Phone/Fax

Practice location:
  • Phone: 303-718-6899
  • Fax: 303-374-2518
Mailing address:
  • Phone: 303-718-6899
  • Fax: 303-374-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0991940
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: