Healthcare Provider Details

I. General information

NPI: 1538623574
Provider Name (Legal Business Name): STEPHANIE PERUZZI CIARKOWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N HIGH ST
DENVER CO
80205-5555
US

IV. Provider business mailing address

2327 ELIOT ST
DENVER CO
80211-5134
US

V. Phone/Fax

Practice location:
  • Phone: 720-754-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPN.0994526-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1642161
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: