1063819308 NPI number — MRS. TAMARA KACEY PHILLIPS R.N.

Table of content: MRS. TAMARA KACEY PHILLIPS R.N. (NPI 1063819308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063819308 NPI number — MRS. TAMARA KACEY PHILLIPS R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
TAMARA
Provider Middle Name:
KACEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEBBER
Provider Other First Name:
TAMARA
Provider Other Middle Name:
KACEY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063819308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15001 E. OXFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-693-1550
Provider Business Mailing Address Fax Number:
303-693-5481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15001 E. OXFORD AVE
Provider Second Line Business Practice Location Address:
EXCELSIOR YOUTH CENTER
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-693-1550
Provider Business Practice Location Address Fax Number:
303-693-5481
Provider Enumeration Date:
12/02/2014

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: 163W00000X , with the licence number:  RN0165225 , 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)





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