Provider Demographics
NPI:1821049750
Name:THEINE, ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:THEINE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:STE 202
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-247-5362
Mailing Address - Fax:970-259-6045
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:STE 202
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-247-5362
Practice Address - Fax:970-259-6045
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-09-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801322Medicare PIN