Provider Demographics
NPI:1194028159
Name:CHANOS, CARRIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:CHANOS
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 1:7400 E CRESTLINE CIR
Mailing Address - Street 2:STE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3652
Mailing Address - Country:US
Mailing Address - Phone:303-792-3242
Mailing Address - Fax:303-792-9403
Practice Address - Street 1:7400 E CRESTLINE CIR
Practice Address - Street 2:STE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3652
Practice Address - Country:US
Practice Address - Phone:303-792-3242
Practice Address - Fax:303-792-9403
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant