Provider Demographics
NPI:1326294638
Name:MAHON, INEZ MUNOZ (NP)
Entity Type:Individual
Prefix:MS
First Name:INEZ
Middle Name:MUNOZ
Last Name:MAHON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E BOULDER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5740
Mailing Address - Country:US
Mailing Address - Phone:719-471-1069
Mailing Address - Fax:719-577-4828
Practice Address - Street 1:1725 E BOULDER ST STE 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5740
Practice Address - Country:US
Practice Address - Phone:719-471-1069
Practice Address - Fax:719-577-4828
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48490363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health