Healthcare Provider Details

I. General information

NPI: 1760377972
Provider Name (Legal Business Name): JUSTINE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUSTINE RENEE REDFIELD RN

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 19TH AVE
DENVER CO
80218-1114
US

IV. Provider business mailing address

12605 E 16TH AVENUE
DENVER CO
80220-2039
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-2000
  • Fax:
Mailing address:
  • Phone: 916-534-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1673417
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1673417
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: