Basic Information
| Provider Information | |||||||||
| NPI: | 1578796355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISPIRETA | ||||||||
| FirstName: | HERNANDO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ACNPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8950 E LOWRY BLVD | ||||||||
| Address2: | INNOVAGE LOWRY ATTN: GAYLE WASHINGTON | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038694664 | ||||||||
| FaxNumber: | 3039961600 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 E 124TH AVE | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802412402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033271189 | ||||||||
| FaxNumber: | 3033271197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CNP-02455 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | ARNP9217836 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LC0200X | CNP-02455 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | 364SG0600X | APN 0991183-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology | 363LG0600X | APN.991183-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | CO | MEDICAID |