Provider Demographics
NPI:1093991820
Name:VANDERZYDEN, MARIANILDA ORRACA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARIANILDA
Middle Name:ORRACA
Last Name:VANDERZYDEN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1086
Mailing Address - Country:US
Mailing Address - Phone:303-239-7031
Mailing Address - Fax:303-239-7088
Practice Address - Street 1:260 S KIPLING ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1086
Practice Address - Country:US
Practice Address - Phone:303-239-7031
Practice Address - Fax:303-239-7088
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO179452163WC1500X
CA552912163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23322314Medicaid