Provider Demographics
NPI:1740872282
Name:VONGKHAM, NOUCHALEE (CNA, QMAP)
Entity type:Individual
Prefix:
First Name:NOUCHALEE
Middle Name:
Last Name:VONGKHAM
Suffix:
Gender:F
Credentials:CNA, QMAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5258 ELKHART ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-6041
Mailing Address - Country:US
Mailing Address - Phone:720-499-9490
Mailing Address - Fax:
Practice Address - Street 1:5258 ELKHART ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-6041
Practice Address - Country:US
Practice Address - Phone:720-499-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.00781584376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide