Healthcare Provider Details

I. General information

NPI: 1720538424
Provider Name (Legal Business Name): NAIMEH HEYDAR-HOSSEINI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12081 W ALAMEDA PKWY STE 438
LAKEWOOD CO
80228-2701
US

IV. Provider business mailing address

12081 W ALAMEDA PKWY STE 438
LAKEWOOD CO
80228-2701
US

V. Phone/Fax

Practice location:
  • Phone: 303-551-3643
  • Fax: 720-328-9653
Mailing address:
  • Phone: 303-551-3643
  • Fax: 720-328-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992786
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: