Healthcare Provider Details

I. General information

NPI: 1184013336
Provider Name (Legal Business Name): NIEL HARTWELL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY STE 306
LONE TREE CO
80124-5525
US

IV. Provider business mailing address

10103 RIDGEGATE PKWY STE 306
LONE TREE CO
80124-5525
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-8120
  • Fax: 303-225-8130
Mailing address:
  • Phone: 303-225-8120
  • Fax: 303-225-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number0203494
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: