Healthcare Provider Details

I. General information

NPI: 1790223519
Provider Name (Legal Business Name): MYRA PAYSEN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 CROWN CREST BLVD STE 100
PARKER CO
80138-8881
US

IV. Provider business mailing address

9235 CROWN CREST BLVD STE 100
PARKER CO
80138-8881
US

V. Phone/Fax

Practice location:
  • Phone: 720-458-6543
  • Fax: 720-458-6544
Mailing address:
  • Phone: 720-458-6543
  • Fax: 720-458-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015508
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: