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General NPI Number Information
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NPI Number | 1538979133
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Entity Type | Organization
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Legal Business Name | COLORADO WELLNESS GROUP
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 4704 HARLAN ST STE 340
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City | DENVER
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State | CO
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Zip | 80212-7418
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Country | US
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Telephone | 303-801-7241
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Fax |
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Provider Business Mailing Address
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Address Line | 5440 LOWELL BLVD
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City | DENVER
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State | CO
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Zip | 80221-7316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AUDREY STROCK
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Credential | DNP, AGPCNP, PMHNP
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Telephone | 303-416-7193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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