Provider Demographics
NPI:1548017817
Name:HUERTA, CARMELITA (LPN)
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:
Last Name:HUERTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CARMELITA
Other - Middle Name:
Other - Last Name:HUERTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:821 GLEN AYRE ST
Mailing Address - Street 2:
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9533
Mailing Address - Country:US
Mailing Address - Phone:720-220-0514
Mailing Address - Fax:
Practice Address - Street 1:5 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1603
Practice Address - Country:US
Practice Address - Phone:720-909-6008
Practice Address - Fax:720-909-6011
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0042895164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse