Provider Demographics
NPI:1225579543
Name:DREESEN, TRACI (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:DREESEN
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 1:1420 W CANAL CT STE 10
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5660
Mailing Address - Country:US
Mailing Address - Phone:303-791-2841
Mailing Address - Fax:
Practice Address - Street 1:1420 W CANAL CT
Practice Address - Street 2:SUITE 10
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5655
Practice Address - Country:US
Practice Address - Phone:303-791-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004942363AM0700X
CO0004942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical