Basic Information
| Provider Information | |||||||||
| NPI: | 1174865752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACRES | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | DALE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 KEYSTONE TRL | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800209675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705682631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 EXEMPLA CIR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800263370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033384545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2013 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | 163WP2201X | CO | Y | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No ID Information.