Individual
PROVIDENCE PARISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1760 E KEN PRATT BLVD STE 302, LONGMONT, CO 80504-5311
(303) 684-1900
Mailing address
2315 ZLATEN DR APT D108, LONGMONT, CO 80504-2013
(720) 400-9394
Taxonomy
Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
Primary
1684015
CO
Other
Enumeration date
08/27/2025
Last updated
08/27/2025
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