Healthcare Provider Details

I. General information

NPI: 1063104446
Provider Name (Legal Business Name): CONSTANCE VERLE DEINES NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 WABASH ST
DENVER CO
80238-3378
US

IV. Provider business mailing address

3354 WABASH ST
DENVER CO
80238-3378
US

V. Phone/Fax

Practice location:
  • Phone: 720-447-4021
  • Fax:
Mailing address:
  • Phone: 720-447-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1655307
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: