Healthcare Provider Details

I. General information

NPI: 1316456999
Provider Name (Legal Business Name): MRS. TAYLOR ALICIA SEDERBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 DTC PKWY STE 400
GREENWOOD VILLAGE CO
80111-2719
US

IV. Provider business mailing address

5200 DTC PKWY STE 400
GREENWOOD VILLAGE CO
80111-2719
US

V. Phone/Fax

Practice location:
  • Phone: 303-745-0000
  • Fax: 303-708-1834
Mailing address:
  • Phone: 303-745-0000
  • Fax: 303-708-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.0166479
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0993519-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number993519
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: