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General NPI Number Information
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NPI Number | 1215394820
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Entity Type | Individual
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Provider Name | INDIZO STAR MOON RN, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 2850 WELTON ST
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City | DENVER
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State | CO
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Zip | 80205-3020
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Country | US
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Telephone | 720-443-3859
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Fax | 983-203-9599
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Provider Business Mailing Address
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Address Line | 2831 N YORK ST
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City | DENVER
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State | CO
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Zip | 80205-4658
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Country | US
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Telephone | 808-345-7393
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0997135-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.1627689
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License Number State | CO
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