Healthcare Provider Details

I. General information

NPI: 1386565265
Provider Name (Legal Business Name): JOSEPHINE ELISE BOUTHILLIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12211 W ALAMEDA PKWY STE 102
LAKEWOOD CO
80228-2825
US

IV. Provider business mailing address

11742 STONEYBROOKE ST
PARKER CO
80138-8394
US

V. Phone/Fax

Practice location:
  • Phone: 720-722-4195
  • Fax:
Mailing address:
  • Phone: 303-362-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: