Provider Demographics
NPI:1881740496
Name:NYDAM, JANE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:NYDAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N HIGH ST
Mailing Address - Street 2:SUITE 255
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5503
Mailing Address - Country:US
Mailing Address - Phone:303-860-9933
Mailing Address - Fax:303-839-5844
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.466312080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50908227Medicaid
CO50908227Medicaid