Holly Deffert
Individual provider Active NPI Emergency Registered Nurse · Idledale, CO
NPI 1134090624 · NPPES record last updated Sep 16, 2025
Key facts
- NPI
- 1134090624
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Registered Nurse 163WE0003X
- License
- 0191644 (CO)
- Practice address
- 2885 SE Grapevine Rd
Idledale, CO 80453-5014 - Phone
- (720) 240-1360
- NPI assigned
- Sep 16, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0191644 | CO | MD | Emergency Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 0191644 | CO | Yes |
Addresses
Primary practice location
2885 SE Grapevine Rd
Idledale, CO 80453-5014
Mailing address
2885 SE Grapevine Rd
Idledale, CO 80453-5014
Phone (720) 240-1360
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.