Healthcare Provider Details

I. General information

NPI: 1538992078
Provider Name (Legal Business Name): LUCIENNE M NDOUTOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 INDEPENDENCE ST
WHEAT RIDGE CO
80033-6752
US

IV. Provider business mailing address

1025 DECATUR ST APT 1211025
DENVER CO
80204-3341
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-0600
  • Fax:
Mailing address:
  • Phone: 720-218-9846
  • Fax: 720-218-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

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: