Provider Demographics
NPI:1538634019
Name:NEESON, CARA LA MOTTA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:LA MOTTA
Last Name:NEESON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5214
Mailing Address - Country:US
Mailing Address - Phone:203-240-1734
Mailing Address - Fax:
Practice Address - Street 1:8101 E LOWRY BLVD STE 260
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7197
Practice Address - Country:US
Practice Address - Phone:720-859-8222
Practice Address - Fax:720-859-9777
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0994215363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty