Provider Demographics
NPI:1508317413
Name:SUBEDI, RASTRIYATA (FNP)
Entity Type:Individual
Prefix:
First Name:RASTRIYATA
Middle Name:
Last Name:SUBEDI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14062 DENVER WEST PKWY
Mailing Address - Street 2:BLDG 52, SUITE 150
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3187
Mailing Address - Country:US
Mailing Address - Phone:303-893-8300
Mailing Address - Fax:303-825-7927
Practice Address - Street 1:14062 DENVER WEST PKWY
Practice Address - Street 2:BLDG 52, SUITE 150
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3187
Practice Address - Country:US
Practice Address - Phone:303-893-8300
Practice Address - Fax:303-825-7927
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131709363LF0000X
COC-RXN.0000259-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily