Healthcare Provider Details

I. General information

NPI: 1134894561
Provider Name (Legal Business Name): STEPHANIE KERAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 GRANT ST
THORNTON CO
80229-4361
US

IV. Provider business mailing address

10740 STEELE ST
NORTHGLENN CO
80233-4600
US

V. Phone/Fax

Practice location:
  • Phone: 303-451-7800
  • Fax:
Mailing address:
  • Phone: 303-280-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number0192675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: