Healthcare Provider Details

I. General information

NPI: 1750675476
Provider Name (Legal Business Name): DAWN DENISE FANGROW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY STE 312
LONE TREE CO
80124-5525
US

IV. Provider business mailing address

10103 RIDGEGATE PKWY STE 312
LONE TREE CO
80124-5525
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-8888
  • Fax: 866-456-4594
Mailing address:
  • Phone: 303-788-8888
  • Fax: 866-456-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC-APN.0101171-C-CRNA
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2011016048
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: