Healthcare Provider Details

I. General information

NPI: 1679724165
Provider Name (Legal Business Name): BRENDA ANNETTE KUIPHOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14316 W WESLEY CIR
LAKEWOOD CO
80228-5420
US

IV. Provider business mailing address

14316 W WESLEY CIR
LAKEWOOD CO
80228-5420
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-1448
  • Fax:
Mailing address:
  • Phone: 303-988-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number120637
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: