Provider Demographics
NPI:1093049801
Name:DEMASTERS, NAOMI LEAH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:LEAH
Last Name:DEMASTERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 BRIARGATE PKWY.
Mailing Address - Street 2:COLORADO SPRINGS MEDICAL OFFICE
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908
Mailing Address - Country:US
Mailing Address - Phone:303-614-1400
Mailing Address - Fax:
Practice Address - Street 1:4501 BRIARGATE PKWY.
Practice Address - Street 2:COLORADO SPRINGS MEDICAL OFFICE
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908
Practice Address - Country:US
Practice Address - Phone:303-614-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse