Provider Demographics
NPI:1376791442
Name:MORDECAI, KRISTINA DENNISE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DENNISE
Last Name:MORDECAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 E JEWELL AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4510
Mailing Address - Country:US
Mailing Address - Phone:303-783-4734
Mailing Address - Fax:
Practice Address - Street 1:4155 E JEWELL AVE STE 600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4510
Practice Address - Country:US
Practice Address - Phone:720-310-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998186-NP363LP0808X
CO128167163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse