Provider Demographics
NPI:1619393196
Name:KOURI, MINDY (RN, BSN)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:KOURI
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LIMON
Mailing Address - State:CO
Mailing Address - Zip Code:80828-2100
Mailing Address - Country:US
Mailing Address - Phone:719-946-7158
Mailing Address - Fax:
Practice Address - Street 1:465 1ST AVE
Practice Address - Street 2:
Practice Address - City:LIMON
Practice Address - State:CO
Practice Address - Zip Code:80828-2100
Practice Address - Country:US
Practice Address - Phone:719-946-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO164392163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse