Provider Demographics
NPI:1629172085
Name:SIROKMAN, JUDITH ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:SIROKMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1922 S XENIA CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3331
Mailing Address - Country:US
Mailing Address - Phone:303-752-4541
Mailing Address - Fax:303-752-1588
Practice Address - Street 1:8000 E MAPLEWOOD AVE
Practice Address - Street 2:STE 200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4727
Practice Address - Country:US
Practice Address - Phone:303-788-6749
Practice Address - Fax:303-788-6428
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0001109367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84485272Medicaid
375718Medicare ID - Type Unspecified
COCO306010Medicare PIN