Healthcare Provider Details

I. General information

NPI: 1154231140
Provider Name (Legal Business Name): XIMENA CAROLINA CONDE JIMENEZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VILLAGE DR
PAGOSA SPRINGS CO
81147-8368
US

IV. Provider business mailing address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-264-2104
  • Fax: 970-264-2108
Mailing address:
  • Phone: 970-335-2342
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.0339752
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: