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General NPI Number Information
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NPI Number | 1356920573
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Entity Type | Organization
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Legal Business Name | FOOTHILLS VACCINE CLINIC LLC
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 2679 W MAIN ST STE 300-220
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City | LITTLETON
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State | CO
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Zip | 80120-1950
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Country | US
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Telephone | 303-720-9369
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Fax |
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Provider Business Mailing Address
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Address Line | 2679 W MAIN ST
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City | LITTLETON
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State | CO
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Zip | 80120-1950
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Country | US
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Telephone | 720-669-3470
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARCY KOEHN
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Credential |
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Telephone | 303-720-9369
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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 |
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License Number State |
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