Provider Demographics
NPI:1184858581
Name:WARE, ALEATHIA CHANNEL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEATHIA
Middle Name:CHANNEL
Last Name:WARE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 TUTT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3576
Mailing Address - Country:US
Mailing Address - Phone:719-380-6800
Mailing Address - Fax:719-380-6815
Practice Address - Street 1:6140 TUTT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923
Practice Address - Country:US
Practice Address - Phone:719-380-6800
Practice Address - Fax:719-380-6815
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0005996-NP363L00000X
CO110229 / 5996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91224560Medicaid
CO91224560Medicaid