Provider Demographics
NPI:1902540420
Name:ALDECOA, SARA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ALDECOA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5463 N XENIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3870
Mailing Address - Country:US
Mailing Address - Phone:208-871-7295
Mailing Address - Fax:
Practice Address - Street 1:5463 N XENIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3870
Practice Address - Country:US
Practice Address - Phone:208-871-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0202950163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant