Healthcare Provider Details

I. General information

NPI: 1184013500
Provider Name (Legal Business Name): MICHELE RUNDALL-AEMMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

374 S 32ND AVE
BRIGHTON CO
80601-2714
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-4000
  • Fax:
Mailing address:
  • Phone: 303-910-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0095137
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: