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General NPI Number Information
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NPI Number | 1346763448
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Entity Type | Organization
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Legal Business Name | BLUE NILE CLINIC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11275 E MISSISSIPPI AVE STE 2S3
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City | AURORA
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State | CO
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Zip | 80012-2825
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Country | US
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Telephone | 720-400-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 11275 E MISSISSIPPI AVE STE 2S3
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City | AURORA
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State | CO
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Zip | 80012-2825
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Country | US
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Telephone | 720-400-4412
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HANA MENGESHA
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Credential | REGISTERED NURSE
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Telephone | 720-400-4412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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