Healthcare Provider Details

I. General information

NPI: 1710304241
Provider Name (Legal Business Name): HALLIE LYNN OBRANOVIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HEALTH PARK DR STE 100
LOUISVILLE CO
80027-4644
US

IV. Provider business mailing address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-3083
  • Fax: 303-664-1728
Mailing address:
  • Phone: 303-440-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0999312-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: