Basic Information
Provider Information
NPI: 1205041167
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POHL
FirstName: SOFIA
MiddleName: DELGADO
NamePrefix:  
NameSuffix:  
Credential: LPN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5023 W 120TH AVE STE 312
Address2:  
City: BROOMFIELD
State: CO
PostalCode: 800205606
CountryCode: US
TelephoneNumber: 7206449355
FaxNumber:  
Practice Location
Address1: 12230 LIONESS WAY
Address2:  
City: PARKER
State: CO
PostalCode: 801345603
CountryCode: US
TelephoneNumber: 7206449355
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2007
LastUpdateDate: 10/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPN.0994862-NPCOY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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