Healthcare Provider Details

I. General information

NPI: 1669920096
Provider Name (Legal Business Name): RYAN HEDRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5156 E ATLANTIC PL
DENVER CO
80222-4708
US

IV. Provider business mailing address

5156 E ATLANTIC PL
DENVER CO
80222-4708
US

V. Phone/Fax

Practice location:
  • Phone: 970-376-5502
  • Fax:
Mailing address:
  • Phone: 970-376-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1637673
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: