Provider Demographics
NPI:1275858334
Name:PROTHRO, ANTWONETTE MIXON (NCPT)
Entity Type:Individual
Prefix:MS
First Name:ANTWONETTE
Middle Name:MIXON
Last Name:PROTHRO
Suffix:
Gender:F
Credentials:NCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 E. KENTUCKY AVENUE
Mailing Address - Street 2:SUITE 462
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-815-1914
Mailing Address - Fax:303-815-1915
Practice Address - Street 1:4340 E KENTUCKY AVE
Practice Address - Street 2:SUITE 462
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2060
Practice Address - Country:US
Practice Address - Phone:303-815-1914
Practice Address - Fax:303-815-1915
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO091720246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy