Provider Demographics
NPI:1467636787
Name:TABIN, RENAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RENAE
Middle Name:
Last Name:TABIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 S NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4273
Mailing Address - Country:US
Mailing Address - Phone:970-249-7751
Mailing Address - Fax:970-249-5029
Practice Address - Street 1:569 32 RD STE 12
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504
Practice Address - Country:US
Practice Address - Phone:970-523-3544
Practice Address - Fax:970-434-3422
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005322363A00000X
COPA0002974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95084517Medicaid