Provider Demographics
NPI:1265023444
Name:PRONKO, SIARHEI (RN)
Entity Type:Individual
Prefix:
First Name:SIARHEI
Middle Name:
Last Name:PRONKO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17002 E ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3226
Mailing Address - Country:US
Mailing Address - Phone:720-341-2555
Mailing Address - Fax:
Practice Address - Street 1:WATERPARK II, NURSING SERVICES
Practice Address - Street 2:2530 S PARKER ROAD SUITE 300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-641-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1669847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse