Healthcare Provider Details

I. General information

NPI: 1205664794
Provider Name (Legal Business Name): SUSAN M CLOUGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTHPARK DR
LITTLETON CO
80120-5654
US

IV. Provider business mailing address

1000 SOUTHPARK DR
LITTLETON CO
80120-5654
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-1065
  • Fax: 303-733-1699
Mailing address:
  • Phone: 303-744-1065
  • Fax: 303-733-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0999983-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999983-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: