Healthcare Provider Details

I. General information

NPI: 1205020518
Provider Name (Legal Business Name): SUSAN ANNETTE PUTICA BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 E HARVARD AVE
DENVER CO
80231-5968
US

IV. Provider business mailing address

10065 E HARVARD AVE
DENVER CO
80231-5968
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1400
  • Fax:
Mailing address:
  • Phone: 303-614-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number106098
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: