Provider Demographics
NPI:1982824504
Name:ACKMAN, VALERIE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNN
Last Name:ACKMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5082 W 109TH CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2180
Mailing Address - Country:US
Mailing Address - Phone:720-402-2005
Mailing Address - Fax:
Practice Address - Street 1:3600 S LOGAN ST STE 100
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3766
Practice Address - Country:US
Practice Address - Phone:303-839-7980
Practice Address - Fax:303-839-7936
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY432363A00000X
CO0005690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA156790Medicare ID - Type UnspecifiedCALIFORNIA MEDICARE PARTB
P33484Medicare UPIN