Healthcare Provider Details

I. General information

NPI: 1265965982
Provider Name (Legal Business Name): GINA FIDLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 S GAYLORD ST
DENVER CO
80209-4636
US

IV. Provider business mailing address

669 S CORONA ST
DENVER CO
80209-4405
US

V. Phone/Fax

Practice location:
  • Phone: 720-923-2344
  • Fax:
Mailing address:
  • Phone: 303-990-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1625437
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0993132-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: