MEDICARE: STEPHANIE MIRAULT FNP

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
1	363L00000X	Nurse Practitioner	APN.0997812-NP	CO
2	363LF0000X	Family Nurse Practitioner	0172835	CO
3	225000000X	Orthotic Fitter	0997812	CO

General Provider Information

NPI Number	:	1942932322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MIRAULT FNP

Provider Business Mailing Address
First Line	:	25036 E 4TH PL
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80018-1687
Country	:	US
Telephone Number	:	720-347-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	8655 E MONTVIEW BLVD STE 120
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-4299
Country	:	US
Telephone Number	:	720-794-8237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2022
Last Update Date	:	03/09/2026

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