Provider Demographics
NPI:1720538424
Name:HEYDAR-HOSSEINI, NAIMEH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NAIMEH
Middle Name:
Last Name:HEYDAR-HOSSEINI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12081 W ALAMEDA PKWY STE 438
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2701
Mailing Address - Country:US
Mailing Address - Phone:303-551-3643
Mailing Address - Fax:720-328-9653
Practice Address - Street 1:12081 W ALAMEDA PKWY STE 438
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2701
Practice Address - Country:US
Practice Address - Phone:303-551-3643
Practice Address - Fax:720-328-9653
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty