Healthcare Provider Details

I. General information

NPI: 1922340082
Provider Name (Legal Business Name): MICHELLE KAISER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 PARK AVE
FORT LUPTON CO
80621-1929
US

IV. Provider business mailing address

14275 MEADOWLARK LN
BRIGHTON CO
80601-6849
US

V. Phone/Fax

Practice location:
  • Phone: 303-857-6111
  • Fax:
Mailing address:
  • Phone: 303-659-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0096314
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: