Healthcare Provider Details

I. General information

NPI: 1023286507
Provider Name (Legal Business Name): NANCY AMANDA OLDENBURG CST/CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6234 S VAN GORDON WAY
LITTLETON CO
80127
US

IV. Provider business mailing address

6234 S VAN GORDON WAY
LITTLETON CO
80127-2397
US

V. Phone/Fax

Practice location:
  • Phone: 343-653-3444
  • Fax:
Mailing address:
  • Phone: 343-653-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: