Healthcare Provider Details

I. General information

NPI: 1225505746
Provider Name (Legal Business Name): JUSTIN SEAN ASHURST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 MEADOWS DR
LONE TREE CO
80124
US

IV. Provider business mailing address

21163 E JEFFERSON CIR
AURORA CO
80013-7416
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 303-332-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0123449
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: