Provider Demographics
NPI:1831638386
Name:KIANINEJAD, MARYEM (NP)
Entity type:Individual
Prefix:
First Name:MARYEM
Middle Name:
Last Name:KIANINEJAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1345 PLAZA CT N
Mailing Address - Street 2:1A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3531
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:720-206-0434
Practice Address - Street 1:8990 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4537
Practice Address - Country:US
Practice Address - Phone:720-929-1655
Practice Address - Fax:720-206-0434
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992933-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner