Healthcare Provider Details

I. General information

NPI: 1235642471
Provider Name (Legal Business Name): NICOLE LYNN SCHOENBRUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE LYNN VANCE RN

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10792 E 28TH PL
DENVER CO
80238-3222
US

IV. Provider business mailing address

10792 E 28TH PL
DENVER CO
80238-3222
US

V. Phone/Fax

Practice location:
  • Phone: 970-846-2046
  • Fax:
Mailing address:
  • Phone: 970-846-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN160526
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0993683
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: