Provider Demographics
NPI:1134555642
Name:SPIESSBACH, ANNA J (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:J
Last Name:SPIESSBACH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:J
Other - Last Name:SPIESSBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1501 S POTOMAC ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5411
Practice Address - Country:US
Practice Address - Phone:303-699-3060
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004153363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84605022Medicaid
CO84605022Medicaid