1043679087 NPI number — PAMELA NICHOL BRAY RDH

Table of content: KERRY A GARVEY PHD (NPI 1609815448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043679087 NPI number — PAMELA NICHOL BRAY RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAY
Provider First Name:
PAMELA
Provider Middle Name:
NICHOL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICKMAN
Provider Other First Name:
PAMELA
Provider Other Middle Name:
NICHOL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043679087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81423-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-327-4233
Provider Business Mailing Address Fax Number:
970-327-4228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 S ASPEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-327-4233
Provider Business Practice Location Address Fax Number:
970-327-4228
Provider Enumeration Date:
02/18/2016

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: 124Q00000X , with the licence number:  DH.000904428 , 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)