Healthcare Provider Details

I. General information

NPI: 1982435210
Provider Name (Legal Business Name): DANIELA WALTERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 BLAKE ST STE 101
DENVER CO
80205-2058
US

IV. Provider business mailing address

1600 GLENARM PL APT 1004
DENVER CO
80202-4315
US

V. Phone/Fax

Practice location:
  • Phone: 866-628-7828
  • Fax:
Mailing address:
  • Phone: 978-844-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999962-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: