Healthcare Provider Details

I. General information

NPI: 1215243837
Provider Name (Legal Business Name): KIM TEABEAULT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

14178 SUN BLAZE LOOP UNIT C
BROOMFIELD CO
80023-4565
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number175402
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: