Provider Demographics
NPI:1336146273
Name:NASH, SUZANNE C (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:C
Last Name:NASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:C
Other - Last Name:NASH-TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3655 E 104TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4469
Mailing Address - Country:US
Mailing Address - Phone:303-254-8500
Mailing Address - Fax:303-453-1819
Practice Address - Street 1:3655 E 104TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4469
Practice Address - Country:US
Practice Address - Phone:303-254-8500
Practice Address - Fax:303-453-1819
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01334812Medicaid
CB1858Medicare PIN
CO01334812Medicaid
COF55893Medicare UPIN