Provider Demographics
NPI:1376931386
Name:VONDRAK, AUNDREA DOLORES (RN)
Entity Type:Individual
Prefix:
First Name:AUNDREA
Middle Name:DOLORES
Last Name:VONDRAK
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 1:1030 S GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4129
Mailing Address - Country:US
Mailing Address - Phone:720-217-5686
Mailing Address - Fax:
Practice Address - Street 1:1030 S GARRISON ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4129
Practice Address - Country:US
Practice Address - Phone:720-217-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0197731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO$$$$$$$$$OtherSOCIAL SECURITY NUMBER