Provider Demographics
NPI:1710162573
Name:UNREIN, TANYA SUE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SUE
Last Name:UNREIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6070
Mailing Address - Country:US
Mailing Address - Phone:970-346-2826
Mailing Address - Fax:970-346-2711
Practice Address - Street 1:1600 23RD AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6070
Practice Address - Country:US
Practice Address - Phone:970-356-2424
Practice Address - Fax:970-346-2771
Is Sole Proprietor?:No
Enumeration Date:2007-12-29
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO108691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO300090Medicare PIN