Provider Demographics
NPI:1669512539
Name:NEUCKS, JOHANNA L (APN-CNS)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:L
Last Name:NEUCKS
Suffix:
Gender:F
Credentials:APN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 INVERNESS DR W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5095
Mailing Address - Country:US
Mailing Address - Phone:303-730-8858
Mailing Address - Fax:303-889-0838
Practice Address - Street 1:10350 DRANSFELDT RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9673
Practice Address - Country:US
Practice Address - Phone:303-730-8858
Practice Address - Fax:303-889-0838
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217121363L00000X
COAPN.0992574-CNS364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner