Provider Demographics
NPI:1124259114
Name:THROLSON, STEFANIE J (ANP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:J
Last Name:THROLSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-873-5800
Mailing Address - Fax:303-671-4968
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:#210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4528
Practice Address - Country:US
Practice Address - Phone:303-873-5800
Practice Address - Fax:303-671-4968
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP10067363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08002371Medicaid
CO08002371Medicaid