Provider Demographics
NPI:1043885205
Name:NODINE, VERANIQUE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:VERANIQUE
Middle Name:
Last Name:NODINE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 928
Mailing Address - Street 2:11115 W. HWY. 24, UNIT 2C
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814
Mailing Address - Country:US
Mailing Address - Phone:719-687-6416
Mailing Address - Fax:719-687-6501
Practice Address - Street 1:11115 W HWY 24, UNIT 2C
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814
Practice Address - Country:US
Practice Address - Phone:719-687-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28154699A163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health