Provider Demographics
NPI:1427548775
Name:TAVES, ANNLISA S
Entity Type:Individual
Prefix:
First Name:ANNLISA
Middle Name:S
Last Name:TAVES
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 1:13051 E 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-6110
Mailing Address - Country:US
Mailing Address - Phone:720-352-1867
Mailing Address - Fax:
Practice Address - Street 1:13051 E 48TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-6110
Practice Address - Country:US
Practice Address - Phone:720-352-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82-4884623OtherTAX ID