Provider Demographics
NPI:1093240129
Name:MUKOOBA, STELLA ILEPO (RN)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:ILEPO
Last Name:MUKOOBA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16222 E RICE PL
Mailing Address - Street 2:APT B
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-7002
Mailing Address - Country:US
Mailing Address - Phone:720-495-5652
Mailing Address - Fax:
Practice Address - Street 1:16222 E RICE PL
Practice Address - Street 2:APT B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-7002
Practice Address - Country:US
Practice Address - Phone:720-495-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN. 1635172163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse