Healthcare Provider Details

I. General information

NPI: 1306492889
Provider Name (Legal Business Name): ANNA BULOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BLAKE ST
DENVER CO
80205-2406
US

IV. Provider business mailing address

1542 MACARTHUR DR
BOULDER CO
80303-1150
US

V. Phone/Fax

Practice location:
  • Phone: 720-419-2187
  • Fax:
Mailing address:
  • Phone: 303-956-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: