Healthcare Provider Details

I. General information

NPI: 1447539226
Provider Name (Legal Business Name): TERRI EILENE LIGHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRI LIGHT RN

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 INVERNESS DR W SUITE 200
ENGLEWOOD CO
80112-5095
US

IV. Provider business mailing address

9235 W HINSDALE PL
LITTLETON CO
80128-4165
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-0797
  • Fax: 303-797-9342
Mailing address:
  • Phone: 303-973-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number61699
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: