Healthcare Provider Details

I. General information

NPI: 1639680523
Provider Name (Legal Business Name): NATHAN M LITTON PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W 38TH AVE STE 220
DENVER CO
80212-2005
US

IV. Provider business mailing address

4500 W 38TH AVE STE 220
DENVER CO
80212-2005
US

V. Phone/Fax

Practice location:
  • Phone: 303-420-1297
  • Fax: 303-420-2953
Mailing address:
  • Phone: 303-420-1297
  • Fax: 303-420-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0007183
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: