Healthcare Provider Details

I. General information

NPI: 1578096665
Provider Name (Legal Business Name): STACEY COLLEEN WYNNE-URBANOWICZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11293 E IDA PL
ENGLEWOOD CO
80111-4102
US

IV. Provider business mailing address

999 17TH ST STE 500
DENVER CO
80202-2728
US

V. Phone/Fax

Practice location:
  • Phone: 720-406-1164
  • Fax:
Mailing address:
  • Phone: 720-434-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0993022-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: