Healthcare Provider Details

I. General information

NPI: 1063759488
Provider Name (Legal Business Name): MELISSA ANN HENNINGSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 09/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 HURON ST
THORNTON CO
80260-6806
US

IV. Provider business mailing address

8931 HURON ST
THORNTON CO
80260-6806
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-3500
  • Fax:
Mailing address:
  • Phone: 303-853-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199911
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: