Healthcare Provider Details

I. General information

NPI: 1215522396
Provider Name (Legal Business Name): ELEONORA DELIA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8289 E LOWRY BLVD
DENVER CO
80230-7256
US

IV. Provider business mailing address

8289 E LOWRY BLVD
DENVER CO
80230-7256
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-2828
  • Fax:
Mailing address:
  • Phone: 303-321-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN.1627988
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0997374
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: