Provider Demographics
NPI:1548428832
Name:DEMORE, SUZANNE RACHEL (NP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RACHEL
Last Name:DEMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:RACHEL
Other - Last Name:REISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4891 INDEPENDENCE STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80241-8713
Mailing Address - Country:US
Mailing Address - Phone:303-456-5495
Mailing Address - Fax:303-456-7490
Practice Address - Street 1:5265 VANCE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002
Practice Address - Country:US
Practice Address - Phone:303-232-3366
Practice Address - Fax:303-232-8734
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO168293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300935Medicare PIN