Healthcare Provider Details

I. General information

NPI: 1194931659
Provider Name (Legal Business Name): STEPHANIE BEWLEY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FRANKLIN ST TREADMILL DEPT
DENVER CO
80205-5437
US

IV. Provider business mailing address

2045 FRANKLIN ST TREADMILL DEPT
DENVER CO
80205-5437
US

V. Phone/Fax

Practice location:
  • Phone: 303-764-5291
  • Fax: 303-764-5381
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1234
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: