Provider Demographics
NPI:1790177616
Name:CHILDREN'S HOSPITAL COLORADO
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN, CPNP
Authorized Official - Phone:720-777-5070
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:B302
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-5070
Mailing Address - Fax:720-777-7873
Practice Address - Street 1:13123 EAST 16TH AVENUE
Practice Address - Street 2:B302
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-777-5070
Practice Address - Fax:720-777-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN 0991546 NP364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatricsGroup - Multi-Specialty