Provider Demographics
NPI:1326457359
Name:CHASE, GENEA
Entity Type:Individual
Prefix:
First Name:GENEA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S DAWSON WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3897
Mailing Address - Country:US
Mailing Address - Phone:720-863-4799
Mailing Address - Fax:
Practice Address - Street 1:919 S DAWSON WAY
Practice Address - Street 2:UNIT 1
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3897
Practice Address - Country:US
Practice Address - Phone:720-863-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2014-1426439390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1426439Medicaid