Provider Demographics
NPI:1073050225
Name:LAKEWOOD FAMILY HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:LAKEWOOD FAMILY HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:AMINA
Authorized Official - Last Name:ARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:303-578-8191
Mailing Address - Street 1:1990 S GARRISON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2244
Mailing Address - Country:US
Mailing Address - Phone:303-578-8191
Mailing Address - Fax:
Practice Address - Street 1:1990 S GARRISON ST STE 1
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-2244
Practice Address - Country:US
Practice Address - Phone:303-578-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty