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NPI Code Detail

MEDICARE: MRS. BRENDA LEE NELSON PA

MEDICARE: MRS. BRENDA LEE NELSON PA
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
1363A00000XPhysician AssistantPA.0000675CO

General Provider Information

NPI Number : 1720119548
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRENDA LEE NELSON PA
Provider Business Mailing Address
First Line : 1805 SHEA CENTER DR STE 301
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80129-2277
Country : US
Telephone Number : 303-814-0505
Fax Number : 303-814-6491
Provider Business Practice Location Address
First Line : 7280 LAGAE RD STE J
Second Line :
City : CASTLE PINES
State : CO
Zip : 80108-9454
Country : US
Telephone Number : 303-814-0505
Fax Number : 303-814-6491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 10/03/2023

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Directions to “ MRS. BRENDA LEE NELSON PA” Practice Location

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