Provider Demographics
NPI:1417360637
Name:MAEDEKER, JUSTINE APRIL (NP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:APRIL
Last Name:MAEDEKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2754 COMPASS DR STE 377
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8723
Mailing Address - Country:US
Mailing Address - Phone:970-241-2212
Mailing Address - Fax:970-257-2401
Practice Address - Street 1:2754 COMPASS DR STE 377
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8723
Practice Address - Country:US
Practice Address - Phone:970-241-2212
Practice Address - Fax:970-257-2401
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993274363LP0808X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner