Provider Demographics
NPI:1972644979
Name:MEEKER, REX LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:LEE
Last Name:MEEKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11375 JASPER RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9627
Mailing Address - Country:US
Mailing Address - Phone:303-641-1162
Mailing Address - Fax:
Practice Address - Street 1:11375 JASPER RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9627
Practice Address - Country:US
Practice Address - Phone:303-641-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
032948OtherCRNA RECERTIFICATION #
CO78268OtherREGISTERED NURSE #
032948OtherCRNA RECERTIFICATION #