Provider Demographics
NPI:1407924079
Name:DUBLE, DENISE K (NP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:K
Last Name:DUBLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4676 SLEEPY HOLLOW CIR N
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2525
Mailing Address - Country:US
Mailing Address - Phone:719-570-9415
Mailing Address - Fax:719-637-2539
Practice Address - Street 1:4676 SLEEPY HOLLOW CIR N
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-2525
Practice Address - Country:US
Practice Address - Phone:719-570-9415
Practice Address - Fax:719-637-2539
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801679Medicare ID - Type Unspecified