Healthcare Provider Details

I. General information

NPI: 1306427547
Provider Name (Legal Business Name): MOBILE HEALTH TECHNOLOGY WITH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANDREWS DR
DENVER CO
80239-4441
US

IV. Provider business mailing address

545 3RD ST UNIT 2621
MONUMENT CO
80132-4606
US

V. Phone/Fax

Practice location:
  • Phone: 720-449-6616
  • Fax: 720-792-3458
Mailing address:
  • Phone: 720-449-6616
  • Fax: 720-792-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUZAN L PERREAULT
Title or Position: PRINCIPAL
Credential:
Phone: 720-449-6616