Healthcare Provider Details

I. General information

NPI: 1366406670
Provider Name (Legal Business Name): TERRI LYNNE MOLTHER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
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

11675 E PARKER RD
PARKER CO
80138-7819
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number59683
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: