Provider Demographics
NPI:1396149787
Name:DAVALOS, NADYNE (RN, CAC III)
Entity type:Individual
Prefix:
First Name:NADYNE
Middle Name:
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:RN, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 CROSS COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-7964
Mailing Address - Country:US
Mailing Address - Phone:303-989-8975
Mailing Address - Fax:
Practice Address - Street 1:2222 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1224
Practice Address - Country:US
Practice Address - Phone:303-629-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0003618101YA0400X
CO0074855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse