Healthcare Provider Details

I. General information

NPI: 1467702753
Provider Name (Legal Business Name): WILLIAM ALEX TINLEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S KIPLING ST
LAKEWOOD CO
80226-1086
US

IV. Provider business mailing address

1355 PEARL ST #412
DENVER CO
80203-2592
US

V. Phone/Fax

Practice location:
  • Phone: 303-239-7164
  • Fax:
Mailing address:
  • Phone: 303-239-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.0192665
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: