Healthcare Provider Details

I. General information

NPI: 1689615536
Provider Name (Legal Business Name): MANDIE LEE DYKSTRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDIE LEE DYKSTRA NAVARRO MD

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 CASTLE PINES AVE STE 1
JOHNSTOWN CO
80534-7859
US

IV. Provider business mailing address

6801 W 20TH ST UNIT 101
GREELEY CO
80634-9640
US

V. Phone/Fax

Practice location:
  • Phone: 970-587-7881
  • Fax: 970-587-7738
Mailing address:
  • Phone: 970-378-8000
  • Fax: 970-378-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77120
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: