Healthcare Provider Details

I. General information

NPI: 1518958008
Provider Name (Legal Business Name): MELISSA J YANOVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E. HARVARD AVE SUITE 565
DENVER CO
80210-2028
US

IV. Provider business mailing address

PO BOX 970
BROOMFIELD CO
80038-0970
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-3333
  • Fax: 303-733-4441
Mailing address:
  • Phone: 303-777-3333
  • Fax: 303-733-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number238222
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDR.0023822
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: