Organization
SKIN HDC
Active
Other names
Skin Holistic Dermagraphic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
GYWNN WOLFSTAR RN, BSN, BA (REGISTERED NURSE, CEO)
(303) 440-6611
Entity
Organization
Contact information
Practice address
413 SUMMIT BLVD, UNIT 104, BROOMFIELD, CO 80021-8294
(303) 440-6611
(720) 550-8995
Mailing address
413 SUMMIT BLVD, UNIT 104, BROOMFIELD, CO 80021-8294
(303) 440-6611
(720) 550-8995
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0100256
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12767902
CAQH
—
Enumeration date
05/05/2015
Last updated
05/05/2015
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