Provider Demographics
NPI:1306324363
Name:SUYUMOVA, IRINA K (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:K
Last Name:SUYUMOVA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RAMPART WAY STE 300B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6451
Mailing Address - Country:US
Mailing Address - Phone:303-327-4700
Mailing Address - Fax:303-327-4711
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:STE 150
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-991-0993
Practice Address - Fax:303-531-6583
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994021-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner