Healthcare Provider Details

I. General information

NPI: 1477769578
Provider Name (Legal Business Name): ANN K. LUCKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BROADWAY FL 2
DENVER CO
80205-2526
US

IV. Provider business mailing address

1199 S MONACO PKWY
DENVER CO
80224-1809
US

V. Phone/Fax

Practice location:
  • Phone: 303-285-5293
  • Fax: 303-296-4436
Mailing address:
  • Phone: 303-285-5293
  • Fax: 303-296-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: