Healthcare Provider Details

I. General information

NPI: 1215109343
Provider Name (Legal Business Name): LETETIA HOWARD MOBLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LETETIA PAULK MOBLEY

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 STOUT STREET
DENVER CO
80205
US

IV. Provider business mailing address

2111 CHAMPA ST
DENVER CO
80205-2529
US

V. Phone/Fax

Practice location:
  • Phone: 303-293-2220
  • Fax: 303-293-3977
Mailing address:
  • Phone: 303-293-2220
  • Fax: 303-293-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990940-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: