Provider Demographics
NPI:1679648893
Name:RABANAL, MONICA M (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:RABANAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28000 MEADOW DR
Mailing Address - Street 2:#210 ARAPAHOE PEAK HEALTH CENTER
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:303-679-8500
Mailing Address - Fax:303-679-8505
Practice Address - Street 1:28000 MEADOW DR
Practice Address - Street 2:#210
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:303-679-8500
Practice Address - Fax:303-679-8505
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO117012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC544638OtherGROUP PTAN
COC549578OtherPTAN
P85647Medicare UPIN