Provider Demographics
NPI:1205821162
Name:LEASE, ANNE MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:LEASE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:BISANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1800 15TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4500
Mailing Address - Country:US
Mailing Address - Phone:970-350-6953
Mailing Address - Fax:970-350-6965
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4500
Practice Address - Country:US
Practice Address - Phone:970-350-6953
Practice Address - Fax:970-350-6965
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004983-NP363LF0000X
CO176511363L00000X
FLARNP3166182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL500027887OtherMEDICARE RR
CO57427534Medicaid
FL591923037OtherTAX ID
FL500027887OtherMEDICARE RR
COCOA104616Medicare PIN
CO57427534Medicaid