1740290659 NPI number — MRS. TAMARA LYNNE WRISTEN PA-C

Table of content: MRS. TAMARA LYNNE WRISTEN PA-C (NPI 1740290659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740290659 NPI number — MRS. TAMARA LYNNE WRISTEN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRISTEN
Provider First Name:
TAMARA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740290659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 173362
Provider Second Line Business Mailing Address:
CAMPUS BOX 20
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80217-3362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-615-9999
Provider Business Mailing Address Fax Number:
720-778-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1202 5TH ST
Provider Second Line Business Practice Location Address:
PLAZA BUILDING, SUITE 150
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80204-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-556-2525
Provider Business Practice Location Address Fax Number:
303-556-3881
Provider Enumeration Date:
08/09/2006

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: 363A00000X , with the licence number:  632 , 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)





Copyright © 2007-2025 www.npivalidator.com