Individual
GRACE E SLATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
7862 W MANSFIELD PKWY, LAKEWOOD, CO 80235-1934
(303) 987-4546
(303) 987-4547
Mailing address
7862 W MANSFIELD PKWY, LAKEWOOD, CO 80235-1934
(303) 987-4546
(303) 987-4547
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
105107
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01278711
—
CO
05
—
10025570100
—
NE
05
—
1669544813
—
WY
01
—
59931744
MEDICAID GROUP NUMBER
CO
01
—
88150062
MEDICAID GROUP PRACTICE #
CO
Enumeration date
11/14/2006
Last updated
11/10/2015
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