Healthcare Provider Details

I. General information

NPI: 1396026407
Provider Name (Legal Business Name): CAROLYN DACRES, RXS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 E JEWELL AVE STE 225
DENVER CO
80222-4506
US

IV. Provider business mailing address

4155 E JEWELL AVE STE 225
DENVER CO
80222-4506
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-0803
  • Fax: 888-692-9168
Mailing address:
  • Phone: 303-355-0803
  • Fax: 888-692-9168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRXS 1451
License Number StateCO

VIII. Authorized Official

Name: CAROLYN DACRES
Title or Position: SOLE PROPRIETOR
Credential: RXS, CNS
Phone: 303-355-0803