1750317467 NPI number — JAQUELINE R STEFEK CRNA

Table of content: JAQUELINE R STEFEK CRNA (NPI 1750317467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750317467 NPI number — JAQUELINE R STEFEK CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEFEK
Provider First Name:
JAQUELINE
Provider Middle Name:
R
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:
1750317467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4646 S OAK CT
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:
80127-1066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3704 FAIRFAX AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87402-4578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-596-0257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2006

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:  163304 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: CRNA-01176 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: TLRN075343 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: AC006386 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90580834 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08259861 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750317467 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 685594 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38278251 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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