Provider Demographics
NPI:1114113313
Name:MENDOZA, IRMA (RN/BSN)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:MENDOZA
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 1:6162 S WILLOW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5113
Mailing Address - Country:US
Mailing Address - Phone:303-220-9208
Mailing Address - Fax:303-741-4173
Practice Address - Street 1:15400 E 14TH PL STE 309
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5828
Practice Address - Country:US
Practice Address - Phone:303-363-3019
Practice Address - Fax:303-340-9929
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO199078163W00000X
CO43478164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse