1215679139 NPI number — BRITTANY M HENRIKSEN CPNP-PC, RN, BSN

Table of content: BRITTANY M HENRIKSEN CPNP-PC, RN, BSN (NPI 1215679139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215679139 NPI number — BRITTANY M HENRIKSEN CPNP-PC, RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRIKSEN
Provider First Name:
BRITTANY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP-PC, RN, BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215679139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 W 97TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHGLENN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80260-5603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-929-0301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13123 E 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80045-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-777-1234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  APN.0997958-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 1646941 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1646941 . This is a "REGISTERED NURSE LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: APN.0997958-NP . This is a "ADVANCED PRACTICE NURSE PRACTITIONER LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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