Healthcare Provider Details

I. General information

NPI: 1760725022
Provider Name (Legal Business Name): CHARLENE D ARCHULETA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 720-436-4949
  • Fax: 720-423-4325
Mailing address:
  • Phone: 720-436-4949
  • Fax: 720-423-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberAPN.0990702-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990702-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: