Provider Demographics
NPI:1922216266
Name:POULTER, BRUCE DENTON (RN, MPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DENTON
Last Name:POULTER
Suffix:
Gender:M
Credentials:RN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3931
Mailing Address - Country:US
Mailing Address - Phone:720-312-7760
Mailing Address - Fax:
Practice Address - Street 1:1722 14TH ST STE 150
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6334
Practice Address - Country:US
Practice Address - Phone:720-312-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85441163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty