Healthcare Provider Details

I. General information

NPI: 1679940787
Provider Name (Legal Business Name): SUSAN DEHAVEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
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

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

V. Phone/Fax

Practice location:
  • Phone: 303-730-8858
  • Fax: 303-688-5327
Mailing address:
  • Phone: 303-730-8858
  • Fax: 303-688-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: