1164448221 NPI number — DEBRA ANN IVERSON FNP-C, CNS, BC-ADM

Table of content: DEBRA ANN IVERSON FNP-C, CNS, BC-ADM (NPI 1164448221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164448221 NPI number — DEBRA ANN IVERSON FNP-C, CNS, BC-ADM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVERSON
Provider First Name:
DEBRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C, CNS, BC-ADM
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:
1164448221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10485 N. SHERIDAN BLVD
Provider Second Line Business Mailing Address:
UNIT #200
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-466-8344
Provider Business Mailing Address Fax Number:
303-586-2250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10485 N. SHERIDAN BLVD
Provider Second Line Business Practice Location Address:
UNIT #200
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-466-8344
Provider Business Practice Location Address Fax Number:
303-586-2250
Provider Enumeration Date:
07/14/2006

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: 364S00000X , with the licence number:  79473 , 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: 0991009 , 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: 20620106 . This is a "NCBDE-CERTIFIED DIABETES EDUCATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20130117352 . This is a "FNP CERTIFICATION (ANCC)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200600694 . This is a "BC-ADM ADVANCED DIABETES MANAGEMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 79473 . This is a "COLORADO BOARD OF NURSING" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: APN.0991009-NP . This is a "COLORADO BOARD OF NURSING" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com