Healthcare Provider Details

I. General information

NPI: 1841696309
Provider Name (Legal Business Name): LOURDES WILEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 UINTA WAY SUITE 140
DENVER CO
80230-7110
US

IV. Provider business mailing address

495 UINTA WAY SUITE 140
DENVER CO
80230-7110
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-8487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN 0174766
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: