Healthcare Provider Details

I. General information

NPI: 1972091122
Provider Name (Legal Business Name): HARLEY W OPSAHL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 ALBION ST
DENVER CO
80220-4912
US

IV. Provider business mailing address

381 ALBION ST
DENVER CO
80220-4912
US

V. Phone/Fax

Practice location:
  • Phone: 202-468-0744
  • Fax:
Mailing address:
  • Phone: 202-468-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0993845
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: