Provider Demographics
NPI:1609256023
Name:PAINTIN, SEONDRA (RN)
Entity Type:Individual
Prefix:
First Name:SEONDRA
Middle Name:
Last Name:PAINTIN
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:PO BOX 128
Mailing Address - Street 2:308 LAVASTONE CT
Mailing Address - City:WILEY
Mailing Address - State:CO
Mailing Address - Zip Code:81092
Mailing Address - Country:US
Mailing Address - Phone:719-691-1868
Mailing Address - Fax:
Practice Address - Street 1:308 LAVASTONE CT
Practice Address - Street 2:
Practice Address - City:WILEY
Practice Address - State:CO
Practice Address - Zip Code:81092
Practice Address - Country:US
Practice Address - Phone:719-691-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1618586163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse