Provider Demographics
NPI:1386908861
Name:FRALLER, DEIRDRE BRETT (DNP, ANP-C, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:BRETT
Last Name:FRALLER
Suffix:
Gender:F
Credentials:DNP, ANP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INDIANA STREET SUITE 100
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2605
Mailing Address - Country:US
Mailing Address - Phone:303-736-9697
Mailing Address - Fax:
Practice Address - Street 1:430 INDIANA STREET SUITE 100
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2605
Practice Address - Country:US
Practice Address - Phone:303-736-9697
Practice Address - Fax:720-306-5464
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992458-NP363L00000X
CO0992458-NP363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0992458-NPOtherCOLORADO APN
CO0102077-NPOtherCOLORADO RXN (FULL PRESCRIPTIVE AUTHORITY)
CO1640875OtherCOLORADO RN
CO9000162792Medicaid
CO20770057Medicaid
84-0832336OtherKAISER COMMERCIAL