1356729651 NPI number — MISS CHRISTINA RAE IRELAN FNP-BC

Table of content: MISS CHRISTINA RAE IRELAN FNP-BC (NPI 1356729651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356729651 NPI number — MISS CHRISTINA RAE IRELAN FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRELAN
Provider First Name:
CHRISTINA
Provider Middle Name:
RAE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGUILAR
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356729651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3212 TEJON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80211-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-953-5169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3212 TEJON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80211-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-953-5169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  0192701 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0992141 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7315225463 . This is a "PECOS PAC ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: I20161025001982 . This is a "PECOS ENROLLMENT ID" identifier . This identifiers is of the category "OTHER".




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