Healthcare Provider Details

I. General information

NPI: 1245134592
Provider Name (Legal Business Name): LYNNE MARCANGELO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 DOVER ST
WHEAT RIDGE CO
80033-3250
US

IV. Provider business mailing address

4440 DOVER ST
WHEAT RIDGE CO
80033-3250
US

V. Phone/Fax

Practice location:
  • Phone: 303-590-5757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number405300000X
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: