Provider Demographics
NPI:1013552959
Name:NINO, THERSSA (RN CCRN)
Entity Type:Individual
Prefix:
First Name:THERSSA
Middle Name:
Last Name:NINO
Suffix:
Gender:F
Credentials:RN CCRN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:NNIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN CCRN
Mailing Address - Street 1:13120 E 19TH AVE # MCC28819
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2567
Mailing Address - Country:US
Mailing Address - Phone:303-724-8820
Mailing Address - Fax:
Practice Address - Street 1:13120 E 19TH AVE # MCC28819
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2567
Practice Address - Country:US
Practice Address - Phone:303-724-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN113032163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine