Provider Demographics
NPI:1922462654
Name:HUMBLES, CAROLINE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:HUMBLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 E. LOWRY BLVD
Mailing Address - Street 2:INNOVAGE LOWRY ATTN: GAYLE WASHINGTON
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:303-869-4664
Mailing Address - Fax:303-996-1600
Practice Address - Street 1:3551 CHAMBERS RD STE A-D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1330
Practice Address - Country:US
Practice Address - Phone:303-375-0649
Practice Address - Fax:303-375-0986
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991721-NP363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid