Healthcare Provider Details

I. General information

NPI: 1003209727
Provider Name (Legal Business Name): PRIMARY CARE NPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12081 W ALAMEDA PKWY
LAKEWOOD CO
80228-2701
US

IV. Provider business mailing address

12081 W ALAMEDA PKWY
LAKEWOOD CO
80228-2701
US

V. Phone/Fax

Practice location:
  • Phone: 303-551-3643
  • Fax:
Mailing address:
  • Phone: 303-551-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number104008
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number104008
License Number StateCO

VIII. Authorized Official

Name: TAMARA DREES
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 303-551-3643