1841356755 NPI number — JEANA L DRAYSON-STEINBACH FNP-BC, APRN

Table of content: JEANA L DRAYSON-STEINBACH FNP-BC, APRN (NPI 1841356755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841356755 NPI number — JEANA L DRAYSON-STEINBACH FNP-BC, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRAYSON-STEINBACH
Provider First Name:
JEANA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRAYSON
Provider Other First Name:
JEANA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC, APRN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841356755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6293 RED HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80302-9406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-529-9600
Provider Business Mailing Address Fax Number:
303-284-4082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6041 S SYRACUSE WAY STE 220
Provider Second Line Business Practice Location Address:
AGAPE HEALTHCARE
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-482-1988
Provider Business Practice Location Address Fax Number:
720-482-1990
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  5578 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16299 . This is a "NURSE PRACTIONER LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 68191 . This is a "PUBLIC HEALTH NURSE LICEN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: NP-5578 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: RN-184900 . This is a "REGISTERED NURSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 642044 . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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