Healthcare Provider Details

I. General information

NPI: 1881979615
Provider Name (Legal Business Name): LATRICE WALTERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 E HARVARD AVE
DENVER CO
80231-5968
US

IV. Provider business mailing address

7814 S GAYLORD WAY
CENTENNIAL CO
80122-3120
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1500
  • Fax:
Mailing address:
  • Phone: 619-410-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number484099
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number200627
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: