Provider Demographics
NPI:1609849090
Name:DREES, TAMARA DEANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:DEANNE
Last Name:DREES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:SPONSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13770 W ALASKA PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2426
Mailing Address - Country:US
Mailing Address - Phone:303-551-3643
Mailing Address - Fax:720-328-9653
Practice Address - Street 1:12081 W ALAMEDA PKWY
Practice Address - Street 2:PRIMARY CARE NPS
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2701
Practice Address - Country:US
Practice Address - Phone:303-551-3643
Practice Address - Fax:720-328-9653
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67505538Medicaid
CO67505538Medicaid
545358Medicare ID - Type Unspecified