Healthcare Provider Details

I. General information

NPI: 1578041109
Provider Name (Legal Business Name): NKOYO NTUEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12215 ANGELINA DR
PEYTON CO
80831
US

IV. Provider business mailing address

12215 ANGELINA DR
PEYTON CO
80831-7090
US

V. Phone/Fax

Practice location:
  • Phone: 267-815-5035
  • Fax:
Mailing address:
  • Phone: 267-815-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.0332716
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: