Healthcare Provider Details

I. General information

NPI: 1932256773
Provider Name (Legal Business Name): BRONWYN K MULDOON RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 HIGH ST
LYONS CO
80540
US

IV. Provider business mailing address

349 MAIN ST
LYONS CO
80540-1960
US

V. Phone/Fax

Practice location:
  • Phone: 303-823-8813
  • Fax: 303-823-2355
Mailing address:
  • Phone: 303-823-8813
  • Fax: 303-823-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: