1447539226 NPI number — TERRI EILENE LIGHT RN

Table of content: DR. BETHZAIDA ALVAREZ M.D. (NPI 1801009741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447539226 NPI number — TERRI EILENE LIGHT RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIGHT
Provider First Name:
TERRI
Provider Middle Name:
EILENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIGHT
Provider Other First Name:
TERRI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447539226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9235 W HINSDALE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80128-4165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-973-9439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 INVERNESS DR W
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80112-5095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-730-0797
Provider Business Practice Location Address Fax Number:
303-797-9342
Provider Enumeration Date:
08/10/2011

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: 163WP0808X , with the licence number:  61699 , 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: 840472982 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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