Healthcare Provider Details

I. General information

NPI: 1013544626
Provider Name (Legal Business Name): SHERIDAN HODKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE RM 1.362
AURORA CO
80045-2545
US

IV. Provider business mailing address

12605 E 16TH AVE RM 1.362
AURORA CO
80045-2545
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-7148
  • Fax:
Mailing address:
  • Phone: 720-848-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0197838
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: