Provider Demographics
NPI:1659821171
Name:REBECCA FUENTES FELTY NP LLC
Entity Type:Organization
Organization Name:REBECCA FUENTES FELTY NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:FUENTES
Authorized Official - Last Name:FUENTES FELTY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-985-5362
Mailing Address - Street 1:2329 W MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8200
Mailing Address - Country:US
Mailing Address - Phone:720-985-5362
Mailing Address - Fax:
Practice Address - Street 1:2329 W MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8200
Practice Address - Country:US
Practice Address - Phone:720-985-5362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBECCA FUENTES FELTY NP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990735363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27722538Medicaid
CO27722538Medicaid