Healthcare Provider Details

I. General information

NPI: 1912428806
Provider Name (Legal Business Name): AUDRA JEANETTE THEIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 N FRANKLIN ST
DENVER CO
80218-1128
US

IV. Provider business mailing address

1830 N FRANKLIN ST
DENVER CO
80218-1128
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-9343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number124567
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: