Individual
STACY C DERRERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
309 RUSHMORE ST, ELIZABETH, CO 80107-7928
(970) 619-9084
Mailing address
10900 W 44TH AVE, UNIT 200, WHEAT RIDGE, CO 80033-2742
(303) 993-1330
(303) 284-4082
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN.0995141-NP
CO
Other
Enumeration date
12/08/2019
Last updated
01/09/2020
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