=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356225031
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUDREY MICHELLE ST. DENIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 UNION ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80534-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-619-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 927 ELGIN CT
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-6434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-556-3101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1000589-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------