Healthcare Provider Details

I. General information

NPI: 1306172564
Provider Name (Legal Business Name): CRISTEN DENISE JUAREZ L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 W ALAMEDA AVE
LAKEWOOD CO
80226-3007
US

IV. Provider business mailing address

8383 W ALAMEDA AVE
LAKEWOOD CO
80226-3007
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1492
  • Fax: 303-614-1505
Mailing address:
  • Phone: 303-614-1492
  • Fax: 303-614-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number47200
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: