Provider Demographics
NPI:1528524154
Name:RAWLS, IRENE M (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:M
Last Name:RAWLS
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 1:965 WINEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4204
Mailing Address - Country:US
Mailing Address - Phone:719-360-0104
Mailing Address - Fax:
Practice Address - Street 1:965 WINEBROOK WAY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-4204
Practice Address - Country:US
Practice Address - Phone:719-360-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1617705163W00000X
COAPN.0994480-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse