Organization
KETAMINE WELLNESS CENTERS COLORADO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA D JERGER (EXECUTIVE ASSISTANT)
(855) 538-9355
Entity
Organization
Contact information
Practice address
7261 S BROADWAY STE 10L, LITTLETON, CO 80122-8017
(855) 538-9355
(844) 538-9355
Mailing address
7261 S BROADWAY STE 10L, LITTLETON, CO 80122-8017
(855) 538-9355
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/24/2019
Last updated
08/24/2020
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