Healthcare Provider Details

I. General information

NPI: 1336588003
Provider Name (Legal Business Name): LETICIA EVELYN QUESADA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 S NAPLES WAY
AURORA CO
80017-3170
US

IV. Provider business mailing address

857 S NAPLES WAY
AURORA CO
80017-3170
US

V. Phone/Fax

Practice location:
  • Phone: 970-306-9455
  • Fax:
Mailing address:
  • Phone: 970-306-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number20082
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number20082
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: