Provider Demographics
NPI:1538491337
Name:O'MALLEY, ELIZABETH A (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:O'MALLEY
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 1:6162 S. WILLOW DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5114
Mailing Address - Country:US
Mailing Address - Phone:303-220-9200
Mailing Address - Fax:303-220-9208
Practice Address - Street 1:7000 E. BELLEVIEW
Practice Address - Street 2:301
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-220-9200
Practice Address - Fax:303-220-9208
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO191085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33954020Medicaid