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General NPI Number Information
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NPI Number | 1285848051
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN NEUROMONITORING LLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13547 W EXPOSITION DR
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City | LAKEWOOD
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State | CO
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Zip | 80228-3041
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Country | US
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Telephone | 720-244-4498
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Fax | 720-963-0730
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Provider Business Mailing Address
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Address Line | 3464 S WILLOW ST 568
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City | DENVER
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State | CO
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Zip | 80231-4531
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Country | US
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Telephone | 303-755-2900
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Fax | 303-755-0404
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Authorized Official
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Title or Position | OWNER
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Name | JANICE M BRADBURN
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Credential | MS
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Telephone | 720-244-4498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 214
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License Number State | CO
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