Provider Demographics
NPI:1700840774
Name:CAREY, JOHANNA L (NP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:L
Last Name:CAREY
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 1:130 RAMPART WAY
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6440
Mailing Address - Country:US
Mailing Address - Phone:303-327-4700
Mailing Address - Fax:303-327-4711
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:STE 320
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-871-0977
Practice Address - Fax:303-733-2387
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0010188-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19826869Medicaid
COCOA102587Medicare PIN
IN164210NMedicare PIN
IN200451840Medicaid
IN164220NMedicare PIN