1548563331 NPI number — MS. DANA CAROL ENGEL RDH

Table of content: MS. DANA CAROL ENGEL RDH (NPI 1548563331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548563331 NPI number — MS. DANA CAROL ENGEL RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGEL
Provider First Name:
DANA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
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:
1548563331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 IRIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80304-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-443-8500
Provider Business Mailing Address Fax Number:
303-450-3699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9197 GRANT ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80229-4361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-869-2173
Provider Business Practice Location Address Fax Number:
303-450-3699
Provider Enumeration Date:
12/16/2010

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: 124Q00000X , with the licence number:  902808 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 902808 . This is a "STATE OF COLORADO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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