Healthcare Provider Details

I. General information

NPI: 1154253854
Provider Name (Legal Business Name): TYLER THORSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 19TH AVE
DENVER CO
80218-1114
US

IV. Provider business mailing address

10317 BELLWETHER LN
LONE TREE CO
80124-5325
US

V. Phone/Fax

Practice location:
  • Phone: 303-250-0935
  • Fax:
Mailing address:
  • Phone: 303-250-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.1001985-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: