Healthcare Provider Details

I. General information

NPI: 1942031588
Provider Name (Legal Business Name): MADDIE SCOVILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MATTHEW EBERHARD RN

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST
WHEAT RIDGE CO
80033-6715
US

IV. Provider business mailing address

1939 S QUEBEC WAY APT F623
DENVER CO
80231-3503
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number13398606-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: