Provider Demographics
NPI:1790440311
Name:SMITH, EVA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EVA
Other - Middle Name:NICOLE
Other - Last Name:GIDEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2862 S WALDEN ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6169
Mailing Address - Country:US
Mailing Address - Phone:720-589-9479
Mailing Address - Fax:
Practice Address - Street 1:2862 S WALDEN ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6169
Practice Address - Country:US
Practice Address - Phone:720-589-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1643920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse