Provider Demographics
NPI:1295850816
Name:SMITH, ANELLA SUSAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANELLA
Middle Name:SUSAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14613 E ATLANTIC DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1513
Mailing Address - Country:US
Mailing Address - Phone:303-755-1566
Mailing Address - Fax:303-745-3990
Practice Address - Street 1:14613 E ATLANTIC DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1513
Practice Address - Country:US
Practice Address - Phone:303-755-1566
Practice Address - Fax:303-745-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92858236Medicaid
CO92858236Medicaid
COP99361Medicare UPIN