Healthcare Provider Details

I. General information

NPI: 1417492240
Provider Name (Legal Business Name): ELEANOR MAHOOD REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 19TH AVE
DENVER CO
80218-1114
US

IV. Provider business mailing address

PO BOX 1198
DENVER CO
80201-1198
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-2000
  • Fax:
Mailing address:
  • Phone: 415-847-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1645054
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: