Healthcare Provider Details

I. General information

NPI: 1982099149
Provider Name (Legal Business Name): MICHELLE RADIGAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12093 W CROSS DR APT 305
LITTLETON CO
80127-4503
US

IV. Provider business mailing address

12093 W CROSS DR APT 305
LITTLETON CO
80127-4503
US

V. Phone/Fax

Practice location:
  • Phone: 303-949-5787
  • Fax:
Mailing address:
  • Phone: 303-949-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number1628601
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: