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NPI Code Detail

MEDICARE: BRENDA LEE LARSON FNP-C

MEDICARE: BRENDA LEE LARSON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner105593CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CO306791OTHERMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588636120
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA LEE LARSON FNP-C
Provider Business Mailing Address
First Line : 3701 S BROADWAY
Second Line :
City : ENGLEWOOD
State : CO
Zip : 80113-3611
Country : US
Telephone Number : 303-360-6276
Fax Number : 303-761-2787
Provider Business Practice Location Address
First Line : 15132 E HAMPDEN AVE STE G
Second Line :
City : AURORA
State : CO
Zip : 80014-5038
Country : US
Telephone Number : 303-360-6276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 02/08/2019

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