Provider Demographics
NPI:1467483321
Name:VALADE, DAWN (PA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:VALADE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-7921
Mailing Address - Country:US
Mailing Address - Phone:970-674-4992
Mailing Address - Fax:970-686-0845
Practice Address - Street 1:1900 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5114
Practice Address - Country:US
Practice Address - Phone:970-350-2454
Practice Address - Fax:970-350-2447
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67382878Medicaid
COP00287532OtherRAILROAD MEDICARE
COS50347Medicare UPIN
COC803793Medicare PIN