Provider Demographics
NPI:1528284031
Name:KAWECKI, DENISE SHAREN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:SHAREN
Last Name:KAWECKI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-8820
Mailing Address - Fax:303-938-3499
Practice Address - Street 1:101 ERIE PKWY STE 201E
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-4072
Practice Address - Country:US
Practice Address - Phone:303-415-8820
Practice Address - Fax:303-938-3499
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0164963363L00000X
COAPN.0004990-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17331846Medicaid
COC808649Medicare PIN