Basic Information
Provider Information | |||||||||
NPI: | 1780220111 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PRATHER | ||||||||
FirstName: | CAROLYN | ||||||||
MiddleName: | DINSDALE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSN, APRN, FNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DINSDALE | ||||||||
OtherFirstName: | MARY | ||||||||
OtherMiddleName: | CAROLYN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 11750 W 2ND PL STE 150 | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | CO | ||||||||
PostalCode: | 802281724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3034302700 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11750 W 2ND PL STE 150 | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | CO | ||||||||
PostalCode: | 802281724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3034302700 | ||||||||
FaxNumber: | 3034302770 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/20/2019 | ||||||||
LastUpdateDate: | 04/30/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/30/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2012020480 | MO | N |   | Nursing Service Providers | Registered Nurse |   | 363L00000X | C-APN.0001813-C-NP | CO | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.