1518970565 NPI number — AIDA YOHANNES CRNA

Table of content: AIDA YOHANNES CRNA (NPI 1518970565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518970565 NPI number — AIDA YOHANNES CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOHANNES
Provider First Name:
AIDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518970565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840862
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-377-7638
Provider Business Mailing Address Fax Number:
303-780-0787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 E MAPLEWOOD AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-438-3999
Provider Business Practice Location Address Fax Number:
720-439-9500
Provider Enumeration Date:
08/14/2006

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: 367500000X , with the licence number:  APN.0003422 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: ARNP2637582 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 128962 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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