Healthcare Provider Details

I. General information

NPI: 1538541735
Provider Name (Legal Business Name): KRISTINA CANADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 S PARKER RD
AURORA CO
80014-1623
US

IV. Provider business mailing address

5055 S SHAWNEE WAY
AURORA CO
80015-4720
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 913-980-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number183600
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: