Healthcare Provider Details

I. General information

NPI: 1871136994
Provider Name (Legal Business Name): ROSHA DHAKAL AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INDIANA ST STE 280
GOLDEN CO
80401-5069
US

IV. Provider business mailing address

16580 E HIALEAH DR
CENTENNIAL CO
80015-4114
US

V. Phone/Fax

Practice location:
  • Phone: 303-985-1811
  • Fax: 303-985-3917
Mailing address:
  • Phone: 585-789-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number0995025
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995025-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberAPN.0995025-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberAPN.0995025-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: