Healthcare Provider Details

I. General information

NPI: 1497964167
Provider Name (Legal Business Name): LORI DENISE HULL-GROMMESH RN MSN CCRN ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E STAR CT
MONTROSE CO
81401-6702
US

IV. Provider business mailing address

630 E STAR CT
MONTROSE CO
81401-6702
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-1020
  • Fax: 970-252-1041
Mailing address:
  • Phone: 970-252-1020
  • Fax: 970-252-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number656611
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberC-APN.0004052-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: