Healthcare Provider Details

I. General information

NPI: 1891625687
Provider Name (Legal Business Name): IMPERFECTLY PERFECT WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 W LITTLETON BLVD STE 106
LITTLETON CO
80120-2355
US

IV. Provider business mailing address

21699 E QUINCY AVE UNIT F
AURORA CO
80015-2886
US

V. Phone/Fax

Practice location:
  • Phone: 720-296-9744
  • Fax:
Mailing address:
  • Phone: 720-296-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIA C HARDESTY
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 720-296-9744