Provider Demographics
NPI:1962029843
Name:QUEZADA, CAROL DARLENE (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DARLENE
Last Name:QUEZADA
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 1:13917 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8778
Mailing Address - Country:US
Mailing Address - Phone:303-478-9445
Mailing Address - Fax:
Practice Address - Street 1:13917 JACKSON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-8778
Practice Address - Country:US
Practice Address - Phone:303-478-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1620566163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse