Provider Demographics
NPI:1740825629
Name:SMITH, DENISE (NP-C)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CEDAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOSCA
Mailing Address - State:CO
Mailing Address - Zip Code:81146-9522
Mailing Address - Country:US
Mailing Address - Phone:719-298-6600
Mailing Address - Fax:
Practice Address - Street 1:23 CEDAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:MOSCA
Practice Address - State:CO
Practice Address - Zip Code:81146-9522
Practice Address - Country:US
Practice Address - Phone:719-298-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0995177-NP207Q00000X, 363LF0000X
NM67048363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily