Healthcare Provider Details

I. General information

NPI: 1538742010
Provider Name (Legal Business Name): LAURYN ROSE SULLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 W 44TH AVE UNIT 200
WHEAT RIDGE CO
80033-2742
US

IV. Provider business mailing address

10900 W 44TH AVE UNIT 200
WHEAT RIDGE CO
80033-2742
US

V. Phone/Fax

Practice location:
  • Phone: 303-993-1330
  • Fax:
Mailing address:
  • Phone: 303-993-1330
  • Fax: 303-284-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0996300-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: