Basic Information
| Provider Information | |||||||||
| NPI: | 1497363196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORLAND | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1065 JADE ST | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800201862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202096869 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 E 19TH AVE STE 6000 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038617001 | ||||||||
| FaxNumber: | 3038618624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2020 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AG07200155 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | AG07200155 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LP2300X | AG07200155 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.