Provider Demographics
NPI:1336513563
Name:ARDEBILIPOUR, FATEMEH FARIBA (RN)
Entity Type:Individual
Prefix:MS
First Name:FATEMEH
Middle Name:FARIBA
Last Name:ARDEBILIPOUR
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 1:395 W BURGUNDY ST
Mailing Address - Street 2:UNIT 1815
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6610
Mailing Address - Country:US
Mailing Address - Phone:310-428-8277
Mailing Address - Fax:
Practice Address - Street 1:395 W BURGUNDY ST
Practice Address - Street 2:UNIT 1815
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-6610
Practice Address - Country:US
Practice Address - Phone:310-428-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO125151163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse