Provider Demographics
NPI:1154085355
Name:CANDOR MIND AND BODY
Entity type:Organization
Organization Name:CANDOR MIND AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BUSAYO
Authorized Official - Middle Name:BOSE
Authorized Official - Last Name:OBIGBESAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-902-3512
Mailing Address - Street 1:429 N IRVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-1676
Mailing Address - Country:US
Mailing Address - Phone:303-902-3512
Mailing Address - Fax:
Practice Address - Street 1:3401 QUEBEC ST STE 4500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2310
Practice Address - Country:US
Practice Address - Phone:303-459-5909
Practice Address - Fax:720-229-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty