MEDICARE: MISS CHRISTINA RAE IRELAN FNP-BC

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	163W00000X	Registered Nurse	0192701	CO
2	363LF0000X	Family Nurse Practitioner	0992141	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7315225463	OTHER		PECOS PAC ID
2	I20161025001982	OTHER		PECOS ENROLLMENT ID

General Provider Information

NPI Number	:	1356729651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTINA RAE IRELAN FNP-BC

Provider Business Mailing Address
First Line	:	3212 TEJON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3431
Country	:	US
Telephone Number	:	303-953-5169
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 TEJON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3431
Country	:	US
Telephone Number	:	303-953-5169
Fax Number	:

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

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	05/19/2022

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