Healthcare Provider Details

I. General information

NPI: 1023347804
Provider Name (Legal Business Name): CHUREEPORN PARDEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E. 16TH AVE. B395
AURORA CO
80045
US

IV. Provider business mailing address

20749 E. MAPLEWOOD PLACE
CENTENNIAL CO
80016
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-6162
  • Fax: 720-777-7284
Mailing address:
  • Phone: 303-371-6753
  • Fax: 720-777-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3065
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: