| Owl & Eagle Health And Wellness | |
|
430 Indiana St Ste 100 Golden CO 80401-5012 | |
| (303) 736-9697 | |
| (720) 306-5464 |
| Full Name | Owl & Eagle Health And Wellness |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 430 Indiana St Ste 100, Golden, Colorado |
| Authorized Official Name and Position | Mitchell Fraller (CFO) |
| Authorized Official Contact | 3037369697 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Owl & Eagle Health And Wellness 430 Indiana St Ste 100 Golden CO 80401-5012 Ph: (303) 736-9697 | Owl & Eagle Health And Wellness 430 Indiana St Ste 100 Golden CO 80401-5012 Ph: (303) 736-9697 |
| NPI Number | 1548852585 |
|---|---|
| Provider Enumeration Date | 02/10/2021 |
| Last Update Date | 05/16/2023 |
| Certification Date | 05/16/2023 |
| Medicare PECOS PAC ID | 5395146732 |
|---|---|
| Medicare Enrollment ID | O20210623001892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548852585 | NPI | - | NPPES |
| 9000193323 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Deirdre B Fraller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386908861 PECOS PAC ID: 3971751496 Enrollment ID: I20170411002520 |
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