Healthcare Provider Details

I. General information

NPI: 1497792543
Provider Name (Legal Business Name): PETER T PRUTCH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S ONEIDA ST 248
DENVER CO
80224-2549
US

IV. Provider business mailing address

2121 S ONEIDA ST 248
DENVER CO
80224-2549
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-0600
  • Fax: 303-504-0601
Mailing address:
  • Phone: 303-504-0600
  • Fax: 303-504-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70254
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1906
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: