Basic Information
| Provider Information | |||||||||
| NPI: | 1073059259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIITSU | ||||||||
| FirstName: | KOSUKE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD, APN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13120 EAST 19TH AVE C-288-5 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037248555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12348 EAST MOUNTVIEW BLDV 2ND FLOOR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037246242 | ||||||||
| FaxNumber: | 3037249213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2017 | ||||||||
| LastUpdateDate: | 02/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | G145896 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 111689 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | C-APN.0000823-C-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.