Provider Demographics
NPI:1306417621
Name:ROTHE, LYNAE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LYNAE
Middle Name:
Last Name:ROTHE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10494 OURAY ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-0586
Mailing Address - Country:US
Mailing Address - Phone:720-364-1532
Mailing Address - Fax:
Practice Address - Street 1:150 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1951
Practice Address - Country:US
Practice Address - Phone:303-655-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1656866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse