Healthcare Provider Details

I. General information

NPI: 1124571567
Provider Name (Legal Business Name): BONNIE JEANNE BOUDAKIAN R.N., B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 S PARKER RD SUITE 300
AURORA CO
80014-2910
US

IV. Provider business mailing address

3033 S PARKER RD SUITE 300
AURORA CO
80014-2910
US

V. Phone/Fax

Practice location:
  • Phone: 720-577-1804
  • Fax: 720-577-1803
Mailing address:
  • Phone: 720-577-1804
  • Fax: 720-577-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.1637831
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: