Healthcare Provider Details

I. General information

NPI: 1821246836
Provider Name (Legal Business Name): ALISA COLEEN BURKHALTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E HAMPDEN AVE STE 100
ENGLEWOOD CO
80113-2517
US

IV. Provider business mailing address

180 E HAMPDEN AVE STE 100
ENGLEWOOD CO
80113-2517
US

V. Phone/Fax

Practice location:
  • Phone: 303-789-4968
  • Fax:
Mailing address:
  • Phone: 303-789-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number160383
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5333
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: