Provider Demographics
NPI:1578751053
Name:KACZMAREK, ANYA LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANYA
Middle Name:LAUREN
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S MADISON ST STE 226
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3013
Mailing Address - Country:US
Mailing Address - Phone:303-322-7789
Mailing Address - Fax:
Practice Address - Street 1:1595 E RIVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5981
Practice Address - Country:US
Practice Address - Phone:520-293-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005143363A00000X
COPA.0005764363A00000X
AZ4758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant