Healthcare Provider Details

I. General information

NPI: 1366114860
Provider Name (Legal Business Name): FERDINAND ULRICH YOUSSA MOUNGOUE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 09/11/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR FL 4
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

200 EXEMPLA CIR FL 4
LAFAYETTE CO
80026-3370
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996996-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: