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General NPI Number Information
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NPI Number | 1003069774
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Entity Type | Individual
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Provider Name | REBEKAH LYNN PETKOFF FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 12959 S PARKER RD
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City | PARKER
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State | CO
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Zip | 80134-3447
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Country | US
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Telephone | 720-842-4089
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Fax | 720-842-4090
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Provider Business Mailing Address
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Address Line | 1560 S ASH ST
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City | DENVER
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State | CO
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Zip | 80222-3703
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Country | US
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Telephone | 615-969-0007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13686
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0000156-C-NP
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License Number State | CO
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