Provider Demographics
NPI:1104018704
Name:SKINCARE COLORADO PC
Entity Type:Organization
Organization Name:SKINCARE COLORADO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRYWONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-596-7768
Mailing Address - Street 1:4545 E 9TH AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3904
Mailing Address - Country:US
Mailing Address - Phone:303-586-7768
Mailing Address - Fax:303-957-3098
Practice Address - Street 1:4545 E 9TH AVE STE 420
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3904
Practice Address - Country:US
Practice Address - Phone:303-586-7768
Practice Address - Fax:303-957-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44212207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809278Medicare PIN