Healthcare Provider Details

I. General information

NPI: 1609323567
Provider Name (Legal Business Name): SOO ROBERTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HAMPDEN AVE
ENGLEWOOD CO
80113-2702
US

IV. Provider business mailing address

3587 S DAWSON ST
AURORA CO
80014-4402
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-6200
  • Fax:
Mailing address:
  • Phone: 720-394-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number0118963
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: