Healthcare Provider Details

I. General information

NPI: 1518293828
Provider Name (Legal Business Name): JUDY SUE YOUNG R.N,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

2045 FRANKLIN ST
DENVER CO
80205-5437
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-2121
  • Fax: 303-614-1505
Mailing address:
  • Phone: 303-861-2121
  • Fax: 303-614-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number58311
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: