Healthcare Provider Details

I. General information

NPI: 1245758648
Provider Name (Legal Business Name): MANDY DUBE-MUCHINERIPI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W HAMPDEN AVE UNIT 103
ENGLEWOOD CO
80110-7330
US

IV. Provider business mailing address

6895 E HAMPDEN AVE
DENVER CO
80224-3047
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-1699
  • Fax: 303-761-4099
Mailing address:
  • Phone: 303-861-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0993336-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: