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General NPI Number Information
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NPI Number | 1376791442
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Entity Type | Individual
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Provider Name | KRISTINA DENNISE MORDECAI
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Gender | Female
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 4155 E JEWELL AVE STE 600
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City | DENVER
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State | CO
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Zip | 80222-4510
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Country | US
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Telephone | 720-310-2773
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Fax |
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Provider Business Mailing Address
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Address Line | 4155 E JEWELL AVE STE 600
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City | DENVER
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State | CO
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Zip | 80222-4510
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Country | US
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Telephone | 303-783-4734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0998186-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 128167
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License Number State | CO
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