Healthcare Provider Details

I. General information

NPI: 1356650378
Provider Name (Legal Business Name): DUSTY SHANNON DUMAS BSN, RN, CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
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

10065 E HARVARD AVE STE 400
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 TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number189765
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number189765
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number189765
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: