Provider Demographics
NPI:1417053380
Name:WREN, TONYA NAOMI PARKERSON (MD)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:NAOMI PARKERSON
Last Name:WREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:NAOMI
Other - Last Name:PARKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2345 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8117
Mailing Address - Country:US
Mailing Address - Phone:970-773-5713
Mailing Address - Fax:844-300-6560
Practice Address - Street 1:2345 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8117
Practice Address - Country:US
Practice Address - Phone:970-773-5713
Practice Address - Fax:844-300-6560
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC292579Medicaid
SCAA15328533Medicare PIN