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General NPI Number Information
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NPI Number | 1154050128
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Entity Type | Organization
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Legal Business Name | THE 40 20 COLLECTIVE LLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 14143 DENVER WEST PKWY STE 100
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City | LAKEWOOD
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State | CO
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Zip | 80401-3275
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Country | US
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Telephone | 720-594-5556
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Fax |
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Provider Business Mailing Address
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Address Line | 14143 DENVER WEST PKWY STE 100
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City | LAKEWOOD
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State | CO
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Zip | 80401-3275
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Country | US
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Telephone | 720-594-5556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEGHAN DOW
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Credential | DNP
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Telephone | 720-594-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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