Bluewater Dream, LTD

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

128299 Issued in CO

Legal business name

BLUEWATER DREAM, LTD

Doing business as

Passport Health Colorado

Practice address

405 Urban St
Suite 330
Lakewood, CO 80228-1211

Phone

(303) 442-8728

Fax

(303) 984-1590

NPI assigned

Apr 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Michelle D Reesman, R.N.

Title

Executive Director

Phone

(303) 442-8728

Specialties & licenses 1

Addresses

Other names 1

• Passport Health Colorado Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518089994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 URBAN ST",
            "address_2": "SUITE 330",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281211",
            "telephone_number": "303-442-8728",
            "fax_number": "303-984-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 URBAN ST",
            "address_2": "SUITE 330",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281211",
            "telephone_number": "303-442-8728",
            "fax_number": "303-984-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEWATER DREAM, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REESMAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "303-442-8728",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "128299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport Health Colorado",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Registered Nurse in Lakewood, CO
• Providers in Lakewood, CO by specialty
• Registered Nurse in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.