Healthcare Provider Details

I. General information

NPI: 1831392943
Provider Name (Legal Business Name): SHAREEN AMINA DAHLIN-LOPEZ RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9787 HURTY AVE
CONIFER CO
80433-9113
US

IV. Provider business mailing address

9787 HURTY AVE
CONIFER CO
80433-9113
US

V. Phone/Fax

Practice location:
  • Phone: 303-838-9731
  • Fax: 303-838-9731
Mailing address:
  • Phone: 303-838-9731
  • Fax: 303-838-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number90155
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number90155
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number90155
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number90155
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number90155
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number90155
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number90155
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: