Healthcare Provider Details

I. General information

NPI: 1801485594
Provider Name (Legal Business Name): CAROLYN GUBELIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 GRANT ST STE 130
THORNTON CO
80229-4348
US

IV. Provider business mailing address

3275 FLOWER ST
WHEAT RIDGE CO
80033-5868
US

V. Phone/Fax

Practice location:
  • Phone: 844-455-2747
  • Fax:
Mailing address:
  • Phone: 405-206-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996179-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: