Provider Demographics
NPI:1013311216
Name:DAHLBERG, PETER J (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:DAHLBERG
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 S MONACO ST UNIT 3013
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3499
Mailing Address - Country:US
Mailing Address - Phone:210-262-8367
Mailing Address - Fax:
Practice Address - Street 1:5400 WARD RD STE 110
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002
Practice Address - Country:US
Practice Address - Phone:720-727-2690
Practice Address - Fax:720-727-2691
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-16
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126647363LP0808X
COC-APN.0000882-C-NP363LP0808X
COAPN.0994550-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health