Provider Demographics
NPI:1134889629
Name:KRIGBAUM, YINDY
Entity type:Individual
Prefix:
First Name:YINDY
Middle Name:
Last Name:KRIGBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S FEDERAL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-2933
Mailing Address - Country:US
Mailing Address - Phone:303-362-0761
Mailing Address - Fax:303-945-7958
Practice Address - Street 1:615 S FEDERAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-2933
Practice Address - Country:US
Practice Address - Phone:303-362-0761
Practice Address - Fax:303-945-7958
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04J9803747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21309256Medicaid