Healthcare Provider Details

I. General information

NPI: 1457622599
Provider Name (Legal Business Name): EDITH LINDEBURG RN, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2012
Last Update Date: 01/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E 19TH AVE
DENVER CO
80218-1235
US

IV. Provider business mailing address

1719 E 19TH AVE
DENVER CO
80218-1235
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7690
  • Fax: 303-839-7694
Mailing address:
  • Phone: 303-839-7690
  • Fax: 303-839-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number97267
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: