Provider Demographics
NPI:1104373497
Name:STEINBRUECK, ABBIE LANE (PA-C)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:LANE
Last Name:STEINBRUECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GENERAL DELIVERY
Mailing Address - Street 2:
Mailing Address - City:TABERNASH
Mailing Address - State:CO
Mailing Address - Zip Code:80478-9999
Mailing Address - Country:US
Mailing Address - Phone:303-908-1002
Mailing Address - Fax:
Practice Address - Street 1:GENERAL DELIVERY
Practice Address - Street 2:
Practice Address - City:TABERNASH
Practice Address - State:CO
Practice Address - Zip Code:80478-9999
Practice Address - Country:US
Practice Address - Phone:303-908-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant