Provider Demographics
NPI:1821125709
Name:ACKER, PHYLLIS S (RN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:S
Last Name:ACKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:280 EXEMPLA CIR
Mailing Address - Street 2:RHEUMATOLOGY
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3370
Mailing Address - Country:US
Mailing Address - Phone:720-536-7350
Mailing Address - Fax:720-536-7355
Practice Address - Street 1:280 EXEMPLA CIR
Practice Address - Street 2:RHEUMATOLOGY
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:720-536-7350
Practice Address - Fax:720-536-7355
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO113862207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010525OtherKAISER-COMMERCIAL NUMBER