Healthcare Provider Details

I. General information

NPI: 1306668496
Provider Name (Legal Business Name): MRS. DORA SINTIM ISSAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W 14TH AVE
DENVER CO
80204-2203
US

IV. Provider business mailing address

5205 BALFOUR CT
MIDLAND TX
79707-2192
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6741
  • Fax:
Mailing address:
  • Phone: 404-518-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number226800
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number226800
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number226800
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number226800
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: