Provider Demographics
NPI:1184876369
Name:LESTIKOW, RUTH PAGE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:PAGE
Last Name:LESTIKOW
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:PAGE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-436-4949
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-19
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.003449363A00000X, 363AM0700X
CO0003449363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08627509Medicaid
CO08627509Medicaid
CABV334ZMedicare PIN
COCOA107246Medicare PIN