Healthcare Provider Details

I. General information

NPI: 1447407481
Provider Name (Legal Business Name): DONNA LOUISE OSWALD PAC CERTIFIED PHYSIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 E 38TH AVE
DENVER CO
80207-1630
US

IV. Provider business mailing address

7155 E 38TH AVE
DENVER CO
80207-1630
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-7526
  • Fax: 303-861-0268
Mailing address:
  • Phone: 303-321-7526
  • Fax: 303-861-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5601003289
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003097
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: