Healthcare Provider Details

I. General information

NPI: 1407291016
Provider Name (Legal Business Name): AVA HSU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 S ZINNIA ST
LITTLETON CO
80127-2120
US

IV. Provider business mailing address

5506 S ZINNIA ST
LITTLETON CO
80127-2120
US

V. Phone/Fax

Practice location:
  • Phone: 303-979-0216
  • Fax:
Mailing address:
  • Phone: 303-979-0216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number83859
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: