Healthcare Provider Details

I. General information

NPI: 1205821824
Provider Name (Legal Business Name): STACEY LORRAINE HENNESY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 ORCHARD PKWY
WESTMINSTER CO
80023-9206
US

IV. Provider business mailing address

PO BOX 911057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 303-426-2580
  • Fax: 303-426-2590
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35332
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: