Healthcare Provider Details

I. General information

NPI: 1629099320
Provider Name (Legal Business Name): STEVEN S GITTELMAN PMHNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W HAMPDEN AVE STE 215
ENGLEWOOD CO
80110-2218
US

IV. Provider business mailing address

25587 CONIFER RD SUITE 105-603
CONIFER CO
80433-9067
US

V. Phone/Fax

Practice location:
  • Phone: 720-729-4357
  • Fax: 888-232-6842
Mailing address:
  • Phone: 303-204-5129
  • Fax: 303-416-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0003520-CRNA
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0999794-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: