=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972631372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA KRAFCHICK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 01/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6851 S HOLLY CIR STE 260
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-799-4110
-----------------------------------------------------
Fax | 303-662-8365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9000 E NICHOLS AVE STE 240
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-799-4110
-----------------------------------------------------
Fax | 303-662-8365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 30975
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 30975
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------