Healthcare Provider Details

I. General information

NPI: 1144354358
Provider Name (Legal Business Name): DOLLY LEE WARNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 COAL CREEK DRIVE UNIT G
LAFAYETTE CO
80026
US

IV. Provider business mailing address

1455 COAL CREEK DRIVE UNIT G
LAFAYETTE CO
80026
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-2423
  • Fax: 720-302-1622
Mailing address:
  • Phone: 303-665-2423
  • Fax: 720-302-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number109123
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number109123
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: