MEDICARE: KASSANDRA DOMINIQUE HILL CERTIFIED NURSE ASSI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	NA.00713010	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA.00713010	OTHER	CO	CERTIFIED NURSE ASSISTANT

General Provider Information

NPI Number	:	1295190585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA DOMINIQUE HILL CERTIFIED NURSE ASSI

Provider Business Mailing Address
First Line	:	3301 S WHAINGTON ST
Second Line	:	APT.109
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113
Country	:	US
Telephone Number	:	970-697-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 S WHAINGTON ST
Second Line	:	APT.109
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113
Country	:	US
Telephone Number	:	970-697-6060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2015
Last Update Date	:	12/31/2015

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