Provider Demographics
NPI:1053941781
Name:LEDGERWOOD, CHRISTINE YVONNE (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:YVONNE
Last Name:LEDGERWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:WILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2675 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9732
Mailing Address - Country:US
Mailing Address - Phone:720-309-0578
Mailing Address - Fax:
Practice Address - Street 1:14701 E EXPOSITION AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2623
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0122016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse