Healthcare Provider Details

I. General information

NPI: 1952823643
Provider Name (Legal Business Name): LANA JUNE OVERTURF APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 E PRENTICE AVE STE 207
GREENWOOD VILLAGE CO
80111-2905
US

IV. Provider business mailing address

12398 E HARVARD DR
AURORA CO
80014-1920
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone: 720-373-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0993070-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0993070
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: