Healthcare Provider Details

I. General information

NPI: 1073436317
Provider Name (Legal Business Name): MOIRA ELLEN DOHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 18TH ST STE 100
DENVER CO
80211-4297
US

IV. Provider business mailing address

4127 ALCOTT ST
DENVER CO
80211-1750
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-4470
  • Fax:
Mailing address:
  • Phone: 704-650-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0110969-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: