Healthcare Provider Details

I. General information

NPI: 1366799108
Provider Name (Legal Business Name): RICHARD C LEARY REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 E HARVARD AVE STE 400
DENVER CO
80231-5968
US

IV. Provider business mailing address

4148 S CRYSTAL CT APT 1326
AURORA CO
80014-4233
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1400
  • Fax: 303-614-1505
Mailing address:
  • Phone: 720-379-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199628
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: