Healthcare Provider Details

I. General information

NPI: 1750542593
Provider Name (Legal Business Name): TRACA CAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 W 16TH AVE
DENVER CO
80204-1335
US

IV. Provider business mailing address

DEPT 1057
DENVER CO
80291-0001
US

V. Phone/Fax

Practice location:
  • Phone: 303-595-6550
  • Fax: 303-595-6395
Mailing address:
  • Phone: 303-486-5500
  • Fax: 303-486-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number5482
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: