Provider Demographics
NPI:1477056232
Name:ULLRICH, GARRICK SHAWN
Entity Type:Individual
Prefix:MR
First Name:GARRICK
Middle Name:SHAWN
Last Name:ULLRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:ULLRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:12118 W COOPER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4861
Mailing Address - Country:US
Mailing Address - Phone:303-907-4760
Mailing Address - Fax:
Practice Address - Street 1:11900 GRANT ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1117
Practice Address - Country:US
Practice Address - Phone:720-573-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0115040163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0115040OtherCOLORADO STATE BOARD OF NURSING RN