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General NPI Number Information
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NPI Number | 1366872004
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Entity Type | Individual
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Provider Name | KELLI SUSANN DEETER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 6455 YOSEMITE ST, 6TH FLOOR
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111
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Country | US
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Telephone | 303-692-1211
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Fax | 844-434-0379
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Provider Business Mailing Address
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Address Line | 295 MARTIN DR
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City | BOULDER
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State | CO
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Zip | 80305-3442
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Country | US
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Telephone | 970-389-5537
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2013103096
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License Number State | CO
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