Individual
SUELLEN E IKENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4803 WARD RD, WHEAT RIDGE, CO 80033-1902
(303) 338-4545
Mailing address
4803 WARD RD, WHEAT RIDGE, CO 80033-1902
(303) 338-4545
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
112022
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014739
KAISER COMMERIAL NUMBER
CO
05
—
51954028
—
CO
Enumeration date
02/27/2007
Last updated
04/05/2016
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