Healthcare Provider Details

I. General information

NPI: 1871778522
Provider Name (Legal Business Name): MS. MINDY ELLEN RIEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

280 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1000
  • Fax:
Mailing address:
  • Phone: 303-775-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: