Provider Demographics
NPI:1104002609
Name:FASSL, ERIN M (CNM)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:FASSL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-450-6667
Mailing Address - Fax:303-457-6742
Practice Address - Street 1:9141 GRANT ST
Practice Address - Street 2:SUITE B45
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4369
Practice Address - Country:US
Practice Address - Phone:303-450-6667
Practice Address - Fax:303-457-6742
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13192363LF0000X
CO189642367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71306722Medicaid
CO71306722Medicaid